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J Epidemiol Community Health. 2000 November; 54(11): 839–845.
PMCID: PMC1731578

Excess type 2 diabetes in African-American women and men aged 40-74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey

Abstract

OBJECTIVE—To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men.
DESIGN—Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview.
SETTING—Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres.
PARTICIPANTS—961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994.
MAIN RESULTS—Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences.
CONCLUSIONS—Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.


Keywords: diabetes mellitus; ethnic groups; socioeconomic factors

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Selected References

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  • Kumanyika SK. Diet and nutrition as influences on the morbidity/mortality gap. Ann Epidemiol. 1993 Mar;3(2):154–158. [PubMed]
  • Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996 Aug 1;125(3):221–232. [PubMed]
  • Kochanek KD, Maurer JD, Rosenberg HM. Why did black life expectancy decline from 1984 through 1989 in the United States? Am J Public Health. 1994 Jun;84(6):938–944. [PubMed]
  • Brancati FL, Whelton PK, Kuller LH, Klag MJ. Diabetes mellitus, race, and socioeconomic status. A population-based study. Ann Epidemiol. 1996 Jan;6(1):67–73. [PubMed]
  • Cowie CC, Harris MI, Silverman RE, Johnson EW, Rust KF. Effect of multiple risk factors on differences between blacks and whites in the prevalence of non-insulin-dependent diabetes mellitus in the United States. Am J Epidemiol. 1993 Apr 1;137(7):719–732. [PubMed]
  • Resnick HE, Valsania P, Halter JB, Lin X. Differential effects of BMI on diabetes risk among black and white Americans. Diabetes Care. 1998 Nov;21(11):1828–1835. [PubMed]
  • Ainsworth BE, Haskell WL, Leon AS, Jacobs DR, Jr, Montoye HJ, Sallis JF, Paffenbarger RS., Jr Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993 Jan;25(1):71–80. [PubMed]
  • Simon D, Senan C, Garnier P, Saint-Paul M, Papoz L. Epidemiological features of glycated haemoglobin A1c-distribution in a healthy population. The Telecom Study. Diabetologia. 1989 Dec;32(12):864–869. [PubMed]
  • Moses RG, Patterson MJ, Regan JM, Chaunchaiyakul R, Taylor NA, Jenkins AB. A non-linear effect of ambient temperature on apparent glucose tolerance. Diabetes Res Clin Pract. 1997 Apr;36(1):35–40. [PubMed]
  • Asplund J. Seasonal variation of HbA1c in adult diabetic patients. Diabetes Care. 1997 Feb;20(2):234–234. [PubMed]
  • Akanji AO, Bruce M, Frayn K, Hockaday TD, Kaddaha GM. Oral glucose tolerance and ambient temperature in non-diabetic subjects. Diabetologia. 1987 Jun;30(6):431–433. [PubMed]
  • Frayn KN, Whyte PL, Benson HA, Earl DJ, Smith HA. Changes in forearm blood flow at elevated ambient temperature and their role in the apparent impairment of glucose tolerance. Clin Sci (Lond) 1989 Mar;76(3):323–328. [PubMed]
  • Schmidt MI, Matos MC, Branchtein L, Reichelt AJ, Mengue SS, Iochida LC, Duncan BB. Variation in glucose tolerance with ambient temperature. Lancet. 1994 Oct 15;344(8929):1054–1055. [PubMed]
  • Campbell IT, Jarrett RJ, Keen H. Diurnal and seasonal variation in oral glucose tolerance: studies in the Antarctic. Diabetologia. 1975 Apr;11(2):139–145. [PubMed]
  • Behall KM, Scholfield DJ, Hallfrisch JG, Kelsay JL, Reiser S. Seasonal variation in plasma glucose and hormone levels in adult men and women. Am J Clin Nutr. 1984 Dec;40(6 Suppl):1352–1356. [PubMed]
  • Lipton RB, Liao Y, Cao G, Cooper RS, McGee D. Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 1993 Nov 15;138(10):826–839. [PubMed]
  • Winkleby MA, Kraemer HC, Ahn DK, Varady AN. Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1998 Jul 22;280(4):356–362. [PubMed]
  • Davey Smith G, Neaton JD, Wentworth D, Stamler R, Stamler J. Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Lancet. 1998 Mar 28;351(9107):934–939. [PubMed]
  • Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care. 1998 Apr;21(4):518–524. [PubMed]
  • Sumner AE, Kushner H, Lakota CA, Falkner B, Marsh JB. Gender differences in insulin-induced free fatty acid suppression: studies in an African American population. Lipids. 1996 Mar;31 (Suppl):S275–S278. [PubMed]
  • Sumner AE, Kushner H, Sherif KD, Tulenko TN, Falkner B, Marsh JB. Sex differences in African-Americans regarding sensitivity to insulin's glucoregulatory and antilipolytic actions. Diabetes Care. 1999 Jan;22(1):71–77. [PubMed]
  • Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA. 1991 Feb 6;265(5):627–631. [PubMed]
  • Stunkard AJ. Socioeconomic status and obesity. Ciba Found Symp. 1996;201:174–193. [PubMed]
  • Feinstein JS. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993;71(2):279–322. [PubMed]
  • Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996 Oct;86(10):1370–1378. [PubMed]
  • Morris-Prather CE, Harrell JP, Collins R, Leonard KL, Boss M, Lee JW. Gender differences in mood and cardiovascular responses to socially stressful stimuli. Ethn Dis. 1996 Winter-Spring;6(1-2):123–131. [PubMed]
  • Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ. Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol. 1984 Dec;120(6):834–851. [PubMed]
  • Hazuda HP, Haffner SM, Stern MP, Eifler CW. Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol. 1988 Dec;128(6):1289–1301. [PubMed]
  • Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology. 1997 Nov;8(6):621–628. [PubMed]
  • Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82–122. [PubMed]

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