Background: More than 34 million adults ≥18 years have diabetes in the U.S. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, quality of care, and clinical outcomes for adults with diabetes. Intersectionality, defined as having multiple marginalized/disadvantaged social identities that reflect larger-scale inequalities and systems of oppression, may contribute to diabetes disparities. The study objective was to assess differences in the relationship between intersectionality and social risk factors between men and women with diabetes.
Methods: Data of 2,476 adults (weighted sample = 1,144,573) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The outcomes were physical and mental health quality of life, and the predictor was intersectionality summed as Non-Hispanic White, age ≥65 years, unemployment, less than high school education, and income <$25K. Covariates included comorbidities, insurance, region, and metropolitan statistical area. Logistic regression models were found for each of the outcomes to assess their independent association with intersectionality.
Results: In the fully adjusted model, women with 3+ intersecting social identities were 4x more likely to have poorer physical health (OR=4.13 (95% CI 0.54, 7.73)) compared to women reporting no intersectionality. Men with food insecurity were 5x more likely to have poorer mental health (OR=4.93, 95% CI 1.02, 8.84) than men without food insecurity, whereas women with food insecurity were 3x more likely to have poorer mental health (OR=2.56, 95% CI 0.61, 4.51) compared to women without food insecurity. There were no significant associations between intersectionality and housing instability in this sample.
Conclusions: These findings suggest the need for understanding the influence of intersectionality among women with diabetes and social risk factors, especially food insecurity, among men and women with diabetes.
J.S.Williams: None. A.Thorgerson: None. M.N.Ozieh: None. L.E.Egede: None.
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 and R21DK123720)