Black & Hispanic Americans Develop Diabetes Earlier in Life

The mean age at diagnosis of diabetes for non-Hispanic Black and Hispanic adults was 4-7 years earlier than for non-Hispanic white adults.

Over the past 20 years, the prevalence of diabetes has increased. In 2017, diabetes was the seventh leading cause of death in the United States, according to the American Diabetes Association, and this may be an underrepresentation. Over the past two decades, this increased prevalence of diabetes is highest in non-Hispanic Black adults and Hispanic adults, vs. in non-Hispanic white adults. Studies show this could be due to observed racial/ethnic disparities in diabetes complications. In addition, studies have been done that highlight the differences faced in underserved communities that cause patients in these communities to face situations that cause them to develop diabetes at younger ages. Furthermore, studies have shown underserved communities’ barriers that limit access to resources and quality healthcare.

Studies show that as of 2018, the rate of Americans with diabetes was 34.2 million, or 10.5% of the population. Of that 34.2 million Americans with diabetes, 12.5% were of Hispanic ethnicity, and 11.7% were of non-Hispanic Black ethnicity. The objective of this study was to compare the age at diabetes diagnosis by race/ethnicity in the US. This allows us to investigate whether diabetes develops at a younger age in certain nationalities. The study performed was a cross-sectional study that pulled data from four two-year cycles of the National Health and Nutrition Examination Survey. The study data were obtained from January 1st, 2011, until December 31st, 2018. All adults aged 20 or older who self-reported a history of diabetes and their age at diagnosis were included in the analysis. In addition, self-reported race/ethnicity was accessed to investigate health disparities. Finally, the proportion of adults in each racial/ethnic group diagnosed with diabetes before age 40, 35, and 30 were determined. This study analysis excluded adults who were likely to have type 1 diabetes as defined by subjects diagnosed with diabetes before 30 and on insulin monotherapy. P values were all 2-sided, and P< .05 was statistically significant.

The study sample included 3022 participants, 1586 men and 1436 women. Nine hundred forty-six of those participants were of non-Hispanic white ethnicity. The mean age in the non-Hispanic white ethnicity group was age 63. The mean age in the non-Hispanic Black ethnicity group to be diagnosed with diabetes was 59. The mean age in Hispanic ethnicity to be diagnosed with diabetes was 55. The weighted proportion of adults with diabetes diagnoses before the age of 40 was more significant among the Hispanic ethnicity group, 35%, and the non-Hispanic Black ethnicity group at 25.1% compared with non-Hispanic white adults at just 14.4% Pp value

In conclusion, the mean age at diagnosis of diabetes in non-Hispanic Black adults and Hispanic adults from 2011-2018 was 4-7 years earlier than non-Hispanic white adults. Furthermore, non-Hispanic Black adults and Hispanic adults have a 25% higher rate of diabetes diagnosis before age 40. We can potentially attribute the findings of this study to many factors, which include disparities in healthcare in underserved communities. Although results are primarily comparable to other studies highlighting inequalities in healthcare, there are limitations of this study, including reliance on self-reported data and recall bias. More studies would need to be done to draw better conclusions on why non-Hispanic Black adults and Hispanic adults face earlier age diagnoses of diabetes. Nevertheless, the studies will help with future efforts to manage and prevent the earlier onset of diabetes, such as earlier screening in these populations and earlier implementation of healthy lifestyle changes; it may be the benefit of early intervention outweighs the cost in specific populations.

Practice Pearls:

• Diabetes was the seventh leading cause of death in 2017, and this may be significantly underrepresented.
• Non-Hispanic Black adults and Hispanic adults have a 25% higher rate of diabetes diagnosis before 40.
• More studies would need to be done to draw conclusive data on the cause of the increased rate of diagnosis of diabetes in this study population, and implement interventions to lower the rate in this study population.

Wang MC, Shah NS, Carnethon MR, O’Brien MJ, Khan SS. Age at Diagnosis of Diabetes by Race and Ethnicity in the United States From 2011 to 2018. JAMA Intern Med. Published online September 07, 2021.

Statistics about diabetes. Statistics About Diabetes | ADA. September 17, 2021

Erica Hicks, PharmD Candidate 2022, South College School of Pharmacy