Individual sociodemographic factors determine risk of diabetes. However, the association of a multidimensional social vulnerability index (SVI) and incident diabetes is unknown. We used CDC data on incidence of diagnosed diabetes, 2011-2018, in adults ≥20 years and defined county social vulnerability using two CDC indices: SVI minority health (SVI-MH; includes 6 dimensions) and SVI (includes 4 dimensions) . Trends in the annual age-adjusted incident diabetes rate per 1000 adults (AADR) were derived from weighted least squares regression. Year and SVI-MH/SVI were fitted nonlinearly with spline functions to test 2018 vs. 20fold-changes in AADR for levels of SVI-MH/SVI. Expressed by SVI-MH percentiles, low (10th) , median (50th) , and high (90th) vulnerability corresponded to overall AADR of 6.8, 8.5, and 10.5, respectively. In all years, counties with higher vulnerability (ie, higher SVI-MH) had significantly higher AADR. In 2018, compared to 2011, counties with high vulnerability showed a small AADR fold-decrease (0.97 [0.95-0.98]; P<.001) . The AADR fold-decrease was larger in counties with median vulnerability (0.92 [0.90-0.94]; P<.001) . In counties with low vulnerability, there was no AADR fold-change (P=.35) . Results for AADR analyzed by SVI were generally similar.

In summary, US counties with high SVI-MH/SVI had high AADR, and these indices could inform multidimensional interventions for diabetes prevention.


K.R. Bailey: None. A. Vella: Advisory Panel; Crinetics Pharmaceuticals, Inc., Rezolute, Inc., vTv Therapeutics, Zealand Pharma A/S. Other Relationship; Novo Nordisk. M.M. Mielke: Consultant; Biogen, LabCorp.


National Institute on Minority Health and Health Disparities (NIH K23 MD016230)

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