Demographic Disparities of Diabetes

The disease of diabetes is one that most people are familiar with. Chances are, if you are reading this, you know someone with diabetes or have diabetes yourself. While in college, I was fascinated by the development of diabetes and the rate that it was diagnosed in the United States. It truly was an epidemic, and without my knowledge there was a pattern to it’s spread. Diabetes is not a contagious illness, but that doesn’t mean that it can’t sweep through communities like a pathogen. This is a look into who is affected by diabetes and why it affects them.

The big numbers: Health disparities in diabetes

In 2017, the Centers for Disease Control and Prevention, or “CDC”, released a comprehensive report on diabetes in the United States. While numbers have increased since the study was published, the statistics have remained constant. According to the study:

• About 1/10th of the United States currently has diabetes, which is over 30 million people.
• Of that 30 million cases of diabetes, just over 7 million were undiagnosed before the study.
• The growth rate of diabetes, at the time of the study, was 1.5 million new cases per year.
• Pre-diabetic patients outnumber diabetes patients by over double, at 84 million (above the age of 18).¹

As the CDC outlined, a lot of people have diabetes in the United States and those numbers have grown since 2017. These numbers are for diabetes as a whole, including both type 1 and type 2; about 90-95% of diabetes cases are type 2. There is more important information hidden in those big numbers though.

Diabetes by ethnic group

The rate at which diabetes has grown is higher than any epidemiologist would like. I was not studying epidemiology in college though, I was a student of medical anthropology; the study of socio-cultural disease and health. While the sheer number of diabetes cases was astonishing, I was interested in the who and why. This is a break down of diabetes by ethnic groups:

• 7.4% of non-Hispanic whites
• 8.0% of Asian Americans
• 12.1% of Hispanics
• 12.7% of non-Hispanic blacks
• 15.1% of American Indians/Alaskan Natives²

The numbers directly from the American Diabetes Association, from the CDC 2017 report, show a disproportionate rate of diabetes between different ethnicities in the United States. It’s important to know ‘why’ it is twice as likely for an American Indian person to be diagnosed with diabetes than a non-Hispanic white person.

A possible reason for health disparities in diabetes

From what research can tell us, diabetes does not hold any ethnic prejudice. While there are genetic influences to type 2 diabetes, it does not seem to be the cause of the health disparity. There is, however, a correlation between chronic illness and access to healthy whole foods.³ This is a possible cause of the disparity found in diabetes among different ethnic groups. Diabetes is heavily influenced by diet, and food deserts play an important role in how diabetes can spread in an underserved community.

From my own research, in college, with several AI tribes in Southern California, it was gathered that the communities had little access to whole foods because small convenience markets are the most geographically and economically accessible. Some had small farm stands at one point, but they were unable to compete with the convenience store prices. Type 2 diabetes was common among these communities. This trend is similar among other rural-white, Asian, Hispanic and African American neighborhoods where access to whole foods is difficult and dwindling.³ It would appear that the same populations that are systematically susceptible to diabetes are also systematically disadvantaged to diabetes management through healthy diet changes. That is, until the system is changed.

What can be done about health disparities?

Growing food deserts have been shown to be a cause of growing diabetes rates and require immediate attention from public health departments nationwide. The Pennsylvania Fresh Food Financing Initiative found that the introduction of supermarkets to an underserved area improved the availability and accessibility of healthy foods in the community.³ Accessibility means consumption, so making healthy foods more accessible through public and private initiatives is promising for the reduction of disparities seen among underserved communities.

I was once told that "growing your own food is like printing your own money." In a nation where medication costs are high and rising, this has never been a more relevant statement. Community gardens are also a great way to get healthy, fresh foods into the hands of underserved communities. They are also a great way to get multiple generations educated about food production and nutrition, as well as active and outdoors.

A community and public health approach

About a tenth of our national population in the United States are diabetic and a third of the population has either diabetes or pre-diabetes. This is primarily a reflection of growing food deserts and lack of accessibility to fresh, healthy foods in underserved communities. We can combat the growth rate of diabetes and the associated health disparities by taking community access to healthy foods as a management approach, backed by public health initiatives. Community gardens can be a great place to start developing an immune response to diabetes as an epidemic.

I hope this article gave some insight into what diabetes looks like in the United States and spawns ideas of how we can unite as a community to fight diabetes in our communities.