Introduction: Social determinants of health (SDOH) impact well-being. We tested the association between incident diabetes risk and SDOH using 2 measures, the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) .

Methods: We examined 2015-2021 medical and claims data from the UC Data Warehouse for overweight/obese adults (age>18 yrs; BMI>25 kg/m2; >23 if Asian) . We ran 4 cox proportional hazards regression models with an outcome variable of incident diabetes; 1) base model with age, sex, race, ethnicity, income, BMI, prediabetes and comorbidities, 2) base model + ADI, 3) base model + SVI, and 4) base model + ADI and + SVI. Since SDOH indices were missing for ∼17%, we added them using an interaction term with an indicator variable.

Results: Among 36,946 adults, 33,587 (91%) had >1 follow-up assessment. Among these, mean age was 43 yrs, BMI 28 kg/m2, ADI 3.9 (SD 2.4) , SVI 0.34 (SD 0.24) ; 14% had prediabetes. Over 4.6 (SD 3.3) mean follow-up yrs, 715 (2%) developed diabetes. In the base model, incident diabetes risk significantly increased with each additional yr of age (HR 1.03) , unit BMI (HR 1.09) , prediabetes (HR 2.2) , and in Asian (HR 1.5) or other/multi-racial groups (HR 1.6) compared to Whites; risk decreased with hyperlipidemia (HR 0.72) . These associations were significant in all SDOH models (base +ADI, +SVI or +both) . In our SDOH models, incident diabetes risk was not associated with the degree of area deprivation or social vulnerability. However, diabetes risk decreased if ADI estimates (HR 0.54 95%CI 0.38, 0.77) or SVI estimates (HR 0.48 95%CI 0.36, 0.63) were present (vs. undetermined/unknown) . In the SDOH model with both ADI/SVI, diabetes risk decreased if SVI was present (HR 0.49 95%CI 0.34, 0.70) .

Conclusion: In our real-world cohort of overweight/obese adults, the degree of area deprivation or social vulnerability was not associated with risk of incident diabetes when traditional risk factors were available. More studies of SDOH measures are needed to inform national diabetes prevention efforts.


K.Ramm: None. C.Mangione: n/a. T.Moin: None. N.Jackson: None. U.Chung: None. O.Duru: None. K.Shedd: None. S.Soetenga: None. T.B.Loeb: None. D.Elashoff: None. A.B.Hamilton: None.


NIH/NIDDK 1R01DK124503

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