Environmental and Socio-Economic Factors as Contributors to Racial Disparities in Diabetes Prevalence

BACKGROUND: We deployed a study design that attempts to account for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under similar social conditions. DESIGN & METHODS: We compared data from the 2003 National Health Interview Survey (NHIS) with the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study, which was conducted in a racially-integrated urban community without race differences in socioeconomic status. RESULTS: In the NHIS, African Americans had greater adjusted odds of having diabetes compared to whites (OR: 1.61, 95% CI: 1.26-2.04); whereas, in EHDIC-SWB white and African Americans had similar odds of having diabetes (OR: 1.07, 95% CI: 0.71-1.58). Diabetes prevalence for African Americans was similar in NHIS and EHDIC-SWB (10.4%, 95% CI: 9.5-11.4 and 10.5%, 95%CI: 8.5-12.5, respectively). Diabetes prevalence among whites differed for NHIS (6.6%, 95%CI: 6.2-6.9%) and EHDIC-SWB (10.1%, 95%CI: 7.6-12.5%). CONCLUSIONS: Race disparities in diabetes may stem from differences in the health risk environments that African Americans and whites live. When African Americans and whites live in similar risk environments, their health outcomes are more similar.