This study investigated direct and indirect relationships between historic structural racism and a novel measure of contemporary structural racism on prevalence of diabetes, accounting for distribution of race across counties in the US. Structural equation modeling in Stata v17 and an analytic sample of 15,190 census tracts across 157 counties, within 50 states including DC were used. Historic structural racism was defined as Home Owners’ Loan Corporation (HOLC) redlining neighborhood grades. Contemporary structural racism was defined as the structural racism effect index (SREI), a summary score of nine social determinant domains. Mean diabetes prevalence was 11.8%. Historic redlining, SREI, and Black race were directly associated with increased diabetes prevalence. Historic redlining was indirectly associated with increased diabetes prevalence via SREI. Black race was indirectly associated with increased diabetes prevalence through more exposure to historic redlining and higher levels of contemporary structural racism. Both historic and contemporary measures of structural racism are associated with increased diabetes prevalence. Contemporary structural racism is a stronger relationship for the pathway through which Black race is associated with diabetes prevalence and is a pathway through which historic residential redlining influences diabetes prevalence.
L.E. Egede: None. R.J. Walker: None. S. Linde: None.
National Institutes of Health (R01DK118038, R01DK120861, R01MD013826, R01MD017574, R01MD018012)
