Structural racism is accelerating America’s diabetes crisis, Emory study finds

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Structural racism and geographic inequalities are driving the global diabetes crisis forward, leaving people with diabetes 50% more likely to develop cardiovascular disease and twice as likely to die than people without diabetes, especially among minority populations.

A narrative literature review recently published in Lancet, led by Saria Hassan, MD, assistant professor at Emory University School of Medicine and the Rollins School of Public Health, and co-authored by faculty at the ‘Emory Global Diabetes Research Center (EGDRC) and the Morehouse School of Medicine, discusses and summarizes current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people aged 18 and less. As part of The Lancet’s recently published series, “Global Inequity in Diabetes,” the study also assesses the prominent role of structural racism in diabetes disparities and offers recommendations for improving equity in diabetes care.

“Focusing only on adults ignores the extent to which the accelerating epidemic of type 2 diabetes in children and adolescents is contributing to the increased disease burden and worsening disparities across the United States,” Hassan told The Lancet.

The researchers used a conceptual framework to categorize the causes of diabetes disparities across the lifespan, which looked at factors in five domains. In terms of structural racism, researchers have found that it impacts diabetes disparities at all levels, from policies and interpersonal relationships to the community level.

“Your environment in many ways dictates your health,” says Hassan. “It is well established that obesity, health-related behaviors, lifestyle and access to quality care are risk factors for diabetes. However, at the community level, neighborhoods with predominantly black and Hispanic individuals tend to have little space for physical activity, have more food deserts, and higher levels of toxic environmental exposures.

Estimates indicate that diabetes rates are almost 1.5 times higher among minority ethnic groups, such as American Indians and Alaska Natives, Blacks, Hispanics and Asians, compared to the white population.

Significant disparities in diabetes persist in the United States, from the number of people with the disease and with complications to who has access to effective medications. Medical costs and lost wages for people with diabetes amount to $327 billion a year, placing an even greater burden on minority groups and people of lower socioeconomic status.

African Americans are 19% less likely and American Indians and Native Americans 41% less likely to access a new diabetes treatment such as GLP1.

“Because of structural racism, black and Hispanic Americans are more likely to be low-income, which means they are less likely to be able to afford high co-pay drugs or are not insured and underinsured,” says Hassan.

Following their review, the researchers provided key recommendations for community partners, researchers, practitioners, health system administrators and policy makers to reduce disparities. These recommendations include:

Research should be action-oriented, community-based and multidisciplinary. Those who fund research and activities to address diabetes disparities must ensure equitable, sustainable, and cost-effective research that adopts a health equity agenda. Frontline practitioners need to know and understand the multilevel factors that contribute to diabetes disparities. Policy makers must recognize how policies have historically contributed to health disparities and ensure that future policies dismantle these disparities and do not make them worse.

Invited by the American Diabetes Association (ADA), Hassan is set to present the team’s findings and recommendations at the ADA’s 83rd Scientific Sessions in San Diego, Calif., June 23-26. Learn more.

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About the Emory Global Diabetes Research Center: At the Emory Global Diabetes Research Center (EGDRC), we leverage our extensive global network to develop and advance the capabilities of Emory researchers, U.S. and non-U.S., to engage in world-class research on diabetes and other related non-communicable diseases such as stroke, hypertension, heart disease and co-morbid conditions such as tuberculosis, mental health and HIV. Our research aims to understand causes and consequences, investigate methods of prevention and inform policy by exploring risk factors such as socio-demography, nutrition, obesity, physiology and physical activity.

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