Diabetes burden among the US population and its subgroups

Background: Diabetes is a growing public health problem and it is linked to other chronic conditions including cardiovascular diseases (CVD).  Recognizing disparities in diabetes diagnosis by sociodemographic groups is essential for future prevention and intervention efforts.

Methods: A nationally representative sample of US adults 20 years and older (n=36,620) was included. Diabetes was defined as having any of the following: glycohemoglobin ≥6.5%, fasting glucose ≥126mg/dL, two-hour glucose tolerance test ≥200mg/dL, or self-report of having been diagnosed by a physician, in the National Health and Nutrition Examination Survey (NHANES: 1999-2012). Analysis was performed using SAS v9.3 while accounting for the complex sampling design. A multivariable logistic regression model for having diabetes was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (95%CI).

Results: In overall sample, proportion of diabetes increased about 1% (1.1% in 1999 to 2.0% in 2012). Males (11.8% vs. 11.2% females), non-Hispanic Blacks (16.3% vs. 10.3% Whites), widowed/divorced/separated (17.8% vs. 6.1% never married), those with less than high school education (17.8% vs. 7.4% college), and below national poverty level (13.5% vs. 11.0% above) were more likely to have diabetes compared to their corresponding counterparts. About 16.3% and 14.1% of sample with elevated blood pressure and cholesterol levels also have diabetes. In the adjusted model (2^ndgroup being a referent), significant differences in gender (male vs. female [AOR=1.27]:95%CI:1.14-1.41), ethnicity (non-Hispanic Blacks vs. Whites [1.85];1.65-2.10), education (high school/less vs. college[1.61]:1.40-1.87), high blood pressure ([1.83];1.60-2.10) and high cholesterol ([1.35];1.23-1.50) were found. 

Conclusions: Specific sociodemographic groups are more likely to have diabetes diagnosis. Identification of these group differences will enhance understanding of both diabetes etiology and implementation of prevention programs in the future.