1435-P: Heterogeneous Associations of Socioeconomic Status with Metabolic Disease in Racial and Ethnic Subgroups in the United States

Introduction: Unfavorable socioeconomic status (SES) is associated with adverse health outcomes including metabolic disease. However, whether these associations are uniform across US racial and ethnic subpopulations is unknown.

Methods: We examined the race-stratified association of two SES indicators (educational attainment and income-to-poverty ratio) with type 2 diabetes (T2D) and obesity prevalence among adult participants in the National Health and Nutrition Examination Survey 1999-2018. We tested for multiplicative interactions between race or ethnicity and SES on disease prevalence, estimated the heterogeneity of odds ratios (I² statistic), and tested whether the association between SES and T2D was mediated by BMI in racial and ethnic subgroups.

Results: Age-adjusted prevalence of T2D and obesity was higher among non-Hispanic Black, Mexican American, Other Hispanic, and Other/Multi-Racial participants and in those with lower SES. Higher educational attainment and income were independently associated with lower prevalence of T2D and obesity among non-Hispanic White and Asian participants, with smaller or even opposite associations observed among other racial and ethnic groups (e.g., higher income was associated with higher obesity prevalence for non-Hispanic Black participants). The association between SES and T2D was mediated through BMI in non-Hispanic White participants but not non-Hispanic Black, Mexican American, and Other Hispanic participants (29-53% v. 0-9% mediation).

Conclusion: The associations between SES and pathways to metabolic disease are heterogeneous or point in opposite directions depending on racial or ethnic group. To prevent biased estimates, research on socioeconomic health disparities should examine for heterogeneity between groups, particularly racial and ethnic groups, and examine mediation in a longitudinal setting.