Inequalities in Diabetes among African Americans: Genetic Factors, Preventive Measures
In the United States, non-Hispanic Black people are twice as likely to die from diabetes compared to their non-Hispanic white counterparts, according to the U.S. Department of Health and Human Services (2018). This statistic is concerning, especially considering studies that suggest there is no significant genetic difference between white and Black people in terms of their risk of type 2 diabetes (T2DM). So, what factors could be contributing to this disparity?
Environmental, socioeconomic, and behavioral factors play a significant role. Inadequate glycemic control, influenced by lifestyle factors such as diet, exercise, and healthcare access, is a key contributor to complications of T2DM among African Americans. Behavioral challenges in diabetes self-management are also notable, with difficulties spanning individual to societal levels. Social support has been identified as a mediating factor to improve outcomes.
Socioeconomic factors, such as structural racism embedded in housing, education, employment, and healthcare systems, have led to persistent health disparities. African Americans experience worse health outcomes than Whites even at comparable or higher socioeconomic levels. Racism and associated discrimination affect employment opportunities and access to skilled jobs, further perpetuating economic and healthcare inequities that contribute to diabetes risk.
African Americans also face higher rates of undiagnosed diabetes, with about 20% unaware of their condition. This delay in treatment increases the risk of complications such as kidney disease. The social determinants of health, including limited access to healthy foods, safe environments for physical activity, and quality healthcare, also contribute to elevated diabetes risk and poorer disease management.
Historically, legislation has forced African American people to live in less wealthy residential neighborhoods, which may have fewer healthcare centers. Residential segregation can impact African American people's ability to reduce their risk of diabetes due to stress-related factors. Experiencing high levels of stress, including social stress, is a risk factor for diabetes.
A 2021 article found that telomere length, which can be a factor in a person's likelihood of developing diabetes, can vary among African American people, and social stress could affect telomere length. Age-adjusted obesity is higher among African American people than it is among white American people, further increasing the risk of T2DM.
In 2015, a study found that clinical trials of diabetes treatments have often focused on white participants, leaving healthcare professionals treating African American patients with limited appropriate treatment plans. This lack of representation in clinical trials highlights the importance of increasing diversity in research to better understand and address the unique health needs of African American communities.
In conclusion, the elevated T2DM risk in African American populations is largely attributable to social determinants—structural racism, socioeconomic disadvantages, healthcare inequalities, and behavioral factors affecting disease management—rather than genetic differences. Understanding these factors is crucial in developing effective strategies to reduce the disparities in diabetes prevalence and outcomes between racial groups.
[1] American Diabetes Association. (2018). Type 2 diabetes in African Americans. Accessed from https://www.diabetes.org/healthy-living/medication-treatments/treatments-for-diabetes/insulin/type-2-diabetes-in-african-americans
[2] Braveman, P., & Gruskin, S. (2013). Social determinants of health in the United States: what does the evidence tell us? American Journal of Public Health, 103(S1), S1-S7.
[3] Centers for Disease Control and Prevention. (2018). Diabetes among African Americans. Accessed from https://www.cdc.gov/diabetes/library/features/african-americans.html
[4] Krieger, N., & Sidney, S. (2006). Racism and health: a review of the evidence. Annual Review of Public Health, 27, 667-687.
[5] Schneider, J., & Robinson, J. (2018). Diabetes self-management support in African American communities: A systematic review. Journal of Diabetes Research, 2018, 8406170.
- The cultural aspects of race and mental health should be considered when addressing health disparities, such as the higher rate of type 2 diabetes among non-Hispanic Black people in the United States compared to their non-Hispanic white counterparts.
- Multiple factors contribute to the higher prevalence of chronic diseases like type 2 diabetes among African Americans, including environmental, socioeconomic, and behavioral factors.
- Inadequate glycemic control, influenced by lifestyle factors like diet, exercise, and healthcare access, is a key contributor to complications of type 2 diabetes among African Americans.
- Behavioral challenges in diabetes self-management, such as difficulties in managing the disease, have been identified among African Americans at both individual and societal levels.
- Socioeconomic factors, like structural racism, have led to persistent health disparities, with African Americans experiencing worse health outcomes than whites even at comparable or higher socioeconomic levels.
- Diversity and inclusion in medical research, particularly in clinical trials, are crucial to developing effective treatments for chronic diseases like type 2 diabetes, as historically, clinical trials have mostly focused on white participants.
- To reduce disparities in diabetes prevalence and outcomes between racial groups, it's essential to understand and address the unique health needs of diverse communities, including African Americans, and to ensure equitable access to finance, health and wellness resources, and quality healthcare.
