Understanding the disparities: Why Black Americans suffer from higher rates of diabetes

Disparities in U.S. healthcare – part 2

Introduction

Diabetes is a chronic health condition that affects millions of people worldwide, but it disproportionately affects Black Americans. Among the two primary forms of diabetes—type 1 and type 2—type 2 is far more prevalent, accounting for 90% to 95% of all diabetes cases. Studies show that Black Americans have a higher prevalence of diabetes than many other racial and ethnic groups, highlighting a significant public health concern.

The numbers: A disproportionate burden

According to the American Diabetes Association, 12.1% of non-Hispanic Black adults have diabetes, compared to 6.9% of non-Hispanic white adults. The only group with a higher rate of diabetes than Black Americans is American Indians/Alaska Natives, with a rate of 13.6%.

Complications associated with diabetes also occur more frequently in Black Americans. For example:

• Diabetes-related amputation: The rate of diabetes-related amputations among Black Americans is estimated to be twice that of non-Hispanic whites, highlighting another severe complication of unmanaged diabetes.
• Diabetic retinopathy (DR): Rates of DR, a condition where high blood sugar levels damage blood vessels in the retina, are 46% higher in Black Americans than in non-Hispanic whites. If left untreated, DR can lead to vision loss.
• End-stage renal disease (ESRD): Black Americans are 2.6 times more likely than non-Hispanic whites to develop ESRD, a condition where the kidneys fail, requiring dialysis or a kidney transplant.

Why are Black Americans more affected?

Several factors contribute to the increased prevalence of type 2 diabetes in Black Americans. These include both genetic and social determinants of health (SDOH):

• Healthcare barriers: Many Black Americans face difficulties accessing quality healthcare, leading to delayed diagnoses and inadequate diabetes management.
• Limited access to healthy foods: Many Black American communities lack access to affordable, nutritious food, leading to diets high in processed and sugary foods—both risk factors for diabetes.
• Restricted opportunities for physical activity: Safe spaces for exercise, such as parks and recreational areas, may be limited in predominantly Black neighborhoods, making it harder to maintain an active lifestyle.
• Higher levels of stress: Exposure to discrimination and systemic inequities can cause chronic stress, which has been linked to higher risks of obesity and diabetes.

Conclusion

Addressing the disparities in diabetes prevalence among Black Americans requires a multi-faceted approach, including policy changes, improved access to healthcare, and community-based initiatives focused on nutrition and exercise. By advocating for equitable healthcare and making informed lifestyle choices, individuals and communities can work together to reduce the burden of diabetes and improve overall well-being.

This is part two of a series on disparities in healthcare. In future installments, we will explore inequities in treatment access across other high risk diseases, the impact of socioeconomic factors, and emerging advocacy efforts aimed at closing these healthcare gaps.

Read more

• Social Determinants of Health (SDOH) and Their Impact on Breast Cancer Medication Adherence
• Pharmacy deserts: A growing problem in the U.S.
• What is sickle cell disease?

References

• Diabetes Basics. Centers for Disease Control and Prevention; https://www.cdc.gov/diabetes/about/index.html
• Type 2 Diabetes. Centers for Disease Control and Prevention: https://www.cdc.gov/diabetes/about/about-type-2-diabetes.html
• National Diabetes Statistics Report. Centers for Disease Control and Prevention: https://www.cdc.gov/diabetes/php/data-research/index.html#:~:text=Total:%2038.4%20million%20people%20have,older%20(48.8%25)%20have%20prediabetes
• Statistics About Diabetes. American Diabetes Association: https://diabetes.org/about-diabetes/statistics/about-diabetes
• Diabetic retinopathy. Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611
• End-Stage Renal Disease (ESRD). Medicare.gov: https://www.medicare.gov/basics/end-stage-renal-disease
• Jones, Anna. Black adults are a higher risk of developing diabetes due to genetic variations and social health determinants, research shows. University of Alabama at Birmingham News. March 4, 2022: https://www.uab.edu/news/research/item/12675-black-adults-are-at-a-higher-risk-of-developing-diabetes-due-to-genetic-variations-and-social-health-determinants-research-shows
• Diabetes in Black Communities. Understanding Health Inequity. Northwestern University School of Medicine HealthBeat. July 2022: https://www.nm.org/healthbeat/healthy-tips/nutrition/diabetes-in-the-black-community#:~:text=Black%20adults%20in%20the%20U.S.,results%20in%20poorer%20health%20outcomes.%22
• Merschel, Michael. The challenge of diabetes in the Black community needs comprehensive solution. American Heart Association News. July 13, 2021.: https://www.heart.org/en/news/2021/07/13/the-challenge-of-diabetes-in-the-black-community-needs-comprehensive-solutions
• Gorman, Anna. Black, Latino patients much more likely than whites to undergo amputations related to diabetes. CNN. April 26, 2019.: https://www.cnn.com/2019/04/26/health/diabetes-amputation-disparity-partner/index.html
• McLaurin, Natalie, Tabibi, Doonya, Wang, Tianyu, Alhalimi, Taha, Lehrer, H. Matthew, Harrison Jr., Louis, Tanaka, Hirofumi, and Steinhardt, Mary A. Coping With Discrimination Among African Americans With Type 2 Diabetes: Factor Structure and Associations With Diabetes Control, Mental Distress, and Psychosocial Resources. Preventing Chronic Diseases. Vol. 21. January 25, 2024.: https://www.cdc.gov/pcd/issues/2024/23_0189.htm#:~:text=African%20Americans%20are%20disproportionately%20affected,Hispanic%20White%20population%20(2).

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