Background: Health disparities are disproportionately impacting inner-city African Americans, however limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes.

Methods: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A theoretical model was used to specify measurements across the individual level, such as age and comorbidities, community level, such as neighborhood factors and support, and health systems level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health systems factors and regressed against HbA1c.

Results: In the final adjusted model across all four approaches, individual level factors like age (β=-0.05; p<0.001); having 1-3 comorbidities (β=-2.03; p<0.05) having 4-9 comorbidities (β=-2.49; p=0.001) were associated with lower glycemic control. Similarly, male sex (β=0.58; p<0.05), being married (β=1.16; p=0.001), and overweight/obesity (β=1.25; p<0.01) were associated with higher glycemic control. However, community and health system level factors were not significantly associated with glycemic control.

Conclusion: Individual level factors are key drivers of glycemic control among inner-city African Americans. These factors should be targeted for intervention development and delivery. Further research is needed to examine the indirect pathways via community and health system factors that may explain the relationships with glycemic control.


J.A. Campbell: None. L.E. Egede: None.


National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 to L.E.E.)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at