The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67469

Siobhan C. Maty, PhD, MPH, Department of Health Behavior and Health Education, University of North Carolina School of Public Health, 319-C Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440, 919/966.8650, maty@email.unc.edu, Sherman James, PhD, Health Behavior and Health Education, University of Michigan, School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109, and George A. Kaplan, PhD, Epidemiology, University of Michigan, 1010 Sph I, Ann Arbor, MI 48109.

Type 2 diabetes disproportionately affects persons of lower socioeconomic means and persons of color. In the US, blacks are more likely to be of lower socioeconomic position (SEP) than whites.

Our study objective was to determine how SEP and other modifiable risk factors might explain any excess risk of diabetes among black participants [n=648 (12%)/white, n=4,774 (78%)] in the Alameda County Study. Cox proportional hazard models estimated diabetes risk from 1965 to 1999. Childhood SEP was assessed using height and respondent's father°¯s occupation (white- or blue-collar) or years of education. Adult SEP was measured by education (°Ü12/>12 years), income, and occupation (white-collar/blue-collar). Covariates included demographics, hypertension, depression, body composition, behavior, and health care access.

Compared to whites, blacks were more likely to be obese (12% vs. 5% (p<0.0001)), physically inactive (40% vs. 29% (p<0.0001)), from a low childhood SEP (72% vs. 51% (p<0.0001)), and have <12 years of education (79% vs. 61% (p<0.0001)) before diabetes onset. Diabetes risk was 2-fold greater for blacks than whites in unadjusted models [relative hazard (RH) (95% confidence interval) = 2.3 (1.7-3.1)]. The excess risk in blacks was largely explained by demographic and socioeconomic factors [45% risk reduction (RH=1.7 (1.2-2.4)], and body composition, primarily body mass index (BMI) [additional 29% (RH=1.5 (1.1-2.1)].

Socioeconomic inequalities across the lifecourse, and SEP-patterned risk factors, such as obesity and physical inactivity, help explain racial differences in rates of Type 2 diabetes. Therefore, to reduce racial disparities in Type 2 diabetes, we must begin by eliminating social and economic inequities.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Identify the prospective relationship between racial group classification and Type 2 diabetes in a population-based sample.
• Assess the relationship between racial group classification and incident Type 2 diabetes before and after adjustment for social and economic factors, prevalent diseases, behavioral risk factors, and other characteristics.
• Evaluate the finding that the excess risk of Type 2 diabetes observed for black study participants was primarily attributable to socioeconomic disparities and body composition.

Keywords: Social Inequalities, Minority Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.