Background: In the U.S., some Asian subgroups have disproportionately higher burdens of diabetes which vary by country of origin. Social determinants of health (SDOH)—the conditions in which one grows, lives and works- also influence health disparities. We examined whether diabetes prevalence in Asian subgroups varies by SDOH indices using data from a nationally representative sample.
Methods: We pooled weighted data from National Health Interview Survey 2009-2018 for 6,467 participants who reported their ethnicity as Asian (Chinese, Filipino, Asian Indian, and Other Asian [Korean, Vietnamese, Japanese, and other]). We built multivariate logistic regression models assessing the likelihood of diabetes among Asian subgroups by sociodemographic strata of poverty, marital status, education, health insurance and income, adjusting for age, sex, and overweight/obesity status.
Results: Higher income, compared to poverty status was associated with higher odds of diabetes among Chinese (aOR 2.55, 95%CI 2.51-2.60) and lower odds of diabetes among Filipino, Asian Indian and Other Asian groups (aOR 0.93, 95%CI 0.92-0.94; aOR 0.82, 95%CI 0.81-0.83; aOR 0.60, 95%CI 0.60-0.61, respectively). College education was associated with increased odds of diabetes among Asian Indians, compared to less than high school (aOR 1.55, 95%CI 1.51-1.58) though lower odds of diabetes among Chinese, Filipino, and other Asian groups (aOR .09, 95%CI .09-.09; aOR 0.98, 95%CI 0.96-0.99; aOR 0.51, 95%CI 0.50-0.52, respectively). Health insurance coverage was associated with higher odds of diabetes across all groups. Married status was associated with lower odds of diabetes among Chinese (aOR 0.77, 95%CI 0.76-0.78) but higher for Filipino, Asian Indian, and Other Asian groups.
Discussion: Our data show that SDOHs do not have a uniform influence on diabetes risk in Asian subgroups. Future research should account for this variation and consider subgroup-specific solutions to address diabetes-related health disparities.
M.K. Shah: None. N. Gandrakota: None. U. Gujral: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. K. Narayan: None.
National Center for Advancing Translational Sciences (UL1TR002378, KL2TR002381)