Skip to main content
SpringerLink
Log in

Unspoken Consequences of Structural Racism in the USA: Diabetes and COVID-19

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

Black, Indigenous, and People of Color (BIPOC) are disproportionately impacted by the diabetes epidemic. This health inequity, aggravated by environmental, lifestyle, and genetic factors, has been further exacerbated by the COVID-19 pandemic. The increased risk of severe complications due to COVID-19 in BIPOC communities speaks to the importance of understanding the impacts of social and structural factors on health. This report aims to outline the connection between diabetes and vulnerability to COVID-19 through the lens of racism.

Study Design

Review of original report and subsequent modeling and interpretations.

Methods

We reviewed and analyzed original data in relation to health inequity, diabetes, COVID-19, and BIPOC.

Results

This holistic approach framed the disproportionate prevalence of diabetes and vulnerability to COVID-19 not just as a health disparity, but as a health inequity.

Conclusion

Defining the relationship between diabetes, vulnerability to COVID-19, and systems of advantage, such as racism, can further support the design of health interventions and policies that reduce the disproportionate impact of these diseases on the health of BIPOC communities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Links in the manuscript.

Code Availability

Not applicable.

References

  1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.

    Article  PubMed  Google Scholar 

  2. Diabetes Statistics | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics. Accessed 1 May 2023.

  3. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio-Medica Atenei Parm. 2020;91(1):157–60.

    Google Scholar 

  4. Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Cooney E. Why people with diabetes are being hit so hard by COVID-19. STAT; 2020. https://www.statnews.com/2020/10/01/why-people-with-diabetes-are-being-hit-so-hard-by-covid-19/. Accessed  01 May 2023.

    Google Scholar 

  6. American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917–28.

    Article  PubMed Central  Google Scholar 

  7. Williams DR, Lawrence J, Davis B. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–25.

    Article  PubMed  PubMed Central  Google Scholar 

  8. What is Health Inequity?. Health Equity. https://www.vdh.virginia.gov/health-equity/unnatural-causes-is-inequality-making-us-sick/what-is-health-inequity/. Accessed 1 May 2023.

  9. Hamer K, McFarland S, Czarnecka B, Golińska A, Cadena LM, Łużniak-Piecha M, et al. What is an “ethnic group” in ordinary people’s eyes? Different ways of understanding it among American, British, Mexican, and Polish Respondents. Cross-Cult Res. 2020;54(1):28–72.

    Article  Google Scholar 

  10. Riddle MC, Buse JB, Franks PW, Knowler WC, Ratner RE, Selvin E, et al. COVID-19 in people with diabetes: urgently needed lessons from early reports. Diabetes Care. 2020;43(7):1378–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic’s impact in type 1 and type 2 diabetes. Diabetes Care. 2021;44(2):526–32.

    Article  CAS  PubMed  Google Scholar 

  12. de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr. 2020;12:75.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Palamenghi L, Carlucci MM, Graffigna G. Measuring the quality of life in diabetic patients: a scoping review. J Diabetes Res. 2020;2020:5419298.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Naous E, Boulos M, Sleilaty G, Achkar AA, Gannagé-Yared MH. Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic. J Endocrinol Invest. 2022;45(4):763–72.

    Article  CAS  PubMed  Google Scholar 

  15. Czeisler MÉ, Marynak K, Clarke KEN, Salah Z, Shakya I, Thierry JM, et al. Delay or avoidance of medical care because of COVID-19-related concerns - United States, June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(36):1250–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Notterman DA, Mitchell C. Epigenetics and understanding the impact of social determinants of health. Pediatr Clin North Am. 2015;62(5):1227–40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ozturkler Z, Kalkan R. A new perspective of COVID-19 infection: an epigenetics point of view. Glob Med Genet. 2022;9(1):4–6.

    Article  PubMed  Google Scholar 

  18. Ling C, Bacos K, Rönn T. Epigenetics of type 2 diabetes mellitus and weight change - a tool for precision medicine? Nat Rev Endocrinol. 2022;18(7):433–48.

    Article  CAS  PubMed  Google Scholar 

  19. Aroke EN, Joseph PV, Roy A, Overstreet DS, Tollefsbol TO, Vance DE, et al. Could epigenetics help explain racial disparities in chronic pain? J Pain Res. 2019;12:701–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. LeBrón AMW, Spencer M, Kieffer E, Sinco B, Palmisano G. Racial/ethnic discrimination and diabetes-related outcomes among Latinos with type 2 diabetes. J Immigr Minor Health. 2019;21(1):105–14.

    Article  PubMed  Google Scholar 

  21. Steve SL, Tung EL, Schlichtman JJ, Peek ME. Social disorder in adults with type 2 diabetes: building on race, place, and poverty. Curr Diab Rep. 2016;16(8):72.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sullivan S. Inheriting racist disparities in health epigenetics and the transgenerational effects of white racism. Crit Philos Race. 2013;1(2):190–218.

    Article  Google Scholar 

  23. Writer GS. Hispanic paradox explained through epigenetics. GEN - Genetic Engineering and Biotechnology News; 2016. https://www.genengnews.com/topics/omics/hispanic-paradox-explained-through-epigenetics/. Accessed 1 May 2023.

    Google Scholar 

  24. Smith GS, Breakstone H, Dean LT, Thorpe RJ. Impacts of gentrification on health in the US: a systematic review of the literature. J Urban Health Bull N Y Acad Med. 2020;97(6):845–56.

    Google Scholar 

  25. CDC Healthy places - health effects of gentrification 2017. https://www.cdc.gov/healthyplaces/healthtopics/gentrification.htm. Accessed 1 May 2023.

    Google Scholar 

  26. Ding L, Hwang J. Has COVID Reversed gentrification in major U.S. Cities? An empirical examination of residential mobility in gentrifying neighborhoods during the COVID-19 crisis. Federal Reserve Bank of Philadelphia; 2022. p. 22–0. (Working paper (Federal Reserve Bank of Philadelphia)). Report No.: 22–20. https://www.philadelphiafed.org/-/media/frbp/assets/working-papers/2022/wp22-20.pdf. Accessed 1 May 2023.

    Book  Google Scholar 

  27. Njomane L, Telukdarie A. Impact of COVID-19 food supply chain: comparing the use of IoT in three South African supermarkets. Technol Soc. 2022;71:102051.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Do DP, Frank R, Zheng C, Iceland J. Hispanic segregation and poor health: it’s not just Black and White. Am J Epidemiol. 2017;186(8):990–9.

    Article  PubMed  Google Scholar 

  29. Domínguez S, Arford T. It is all about who you know: social capital and health in low-income communities. Health Sociol Rev. 2010;19(1):114.

    Article  Google Scholar 

  30. Anguelovski I. Alternative food provision conflicts in cities: contesting food privilege, injustice, and whiteness in Jamaica Plain, Boston. Geoforum. 2015;58:184–94.

    Article  Google Scholar 

  31. Walker RJ, Strom Williams J, Egede LE. Influence of race, ethnicity and social determinants of health on diabetes outcomes. Am J Med Sci. 2016;351(4):366–73.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sallis JF, Floyd MF, Rodríguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729–37.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ramirez A. Research: Latino communities lack accessible green space Salud America 2019. https://salud-america.org/research-latino-communities-lack-accessible-green-space/. Accessed 1 May 2023.

  34. Booth GL, Creatore MI, Moineddin R, Gozdyra P, Weyman JT, Matheson FI, et al. Unwalkable neighborhoods, poverty, and the risk of diabetes among recent immigrants to Canada compared with long-term residents. Diabetes Care. 2013;36(2):302–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Astell-Burt T, Feng X, Kolt GS. Is neighborhood green space associated with a lower risk of type 2 diabetes? Evidence from 267,072 Australians. Diabetes Care. 2014;37(1):197–201.

    Article  PubMed  Google Scholar 

  36. Rachele JN, Giles-Corti B, Turrell G. Neighbourhood disadvantage and self-reported type 2 diabetes, heart disease and comorbidity: a cross-sectional multilevel study. Ann Epidemiol. 2016;26(2):146–50.

    Article  PubMed  Google Scholar 

  37. Garcia L, Lee A, Zeki Al Hazzouri A, Neuhaus J, Epstein M, Haan M. The impact of neighborhood socioeconomic position on prevalence of diabetes and prediabetes in older latinos: the Sacramento Area Latino study on aging. Hisp Health Care Int. 2015;13(2):77–85.

    Article  PubMed  PubMed Central  Google Scholar 

  38. James GD, Baker P, Badrick E, Mathur R, Hull S, Robson J. Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004-9. J R Soc Med. 2012;105(7):300–8.

    Article  PubMed  Google Scholar 

  39. Chaikiat Å, Li X, Bennet L, Sundquist K. Neighborhood deprivation and inequities in coronary heart disease among patients with diabetes mellitus: a multilevel study of 334,000 patients. Health Place. 2012;18(4):877–82.

    Article  PubMed  Google Scholar 

  40. Pérez-Escamilla R, Putnik P. The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos. J Nutr. 2007;137(4):860–70.

    Article  PubMed  Google Scholar 

  41. Nopal cactus: Benefits, recipes, and nutrition 2022. https://www.medicalnewstoday.com/articles/320293. Accessed 1 May 2023.

  42. Diabetes and Hispanic Americans The Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63. Accessed 1 May 2023.

  43. CDC. Cases, Data, and Surveillance. Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Accessed 1 May 2023.

    Google Scholar 

  44. Diabetes and American Indians/Alaska Natives. The Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=33. Accessed 1 May 2023.

  45. Banerji MA. Diabetes in African Americans: unique pathophysiologic features. Curr Diab Rep. 2004;4(3):219–23.

    Article  PubMed  Google Scholar 

  46. Margaret S, Karina F, Everett H. Racial and ethnic disparities among low-income families. https://webarchive.urban.org/publications/411936.html. Accessed 1 May 2023.

  47. Ebekozien O, Agarwal S, Noor N, Albanese-O’Neill A, Wong JC, Seeherunvong T, et al. Inequities in diabetic ketoacidosis among patients with type 1 diabetes and COVID-19: data from 52 US clinical centers. J Clin Endocrinol Metab. 2021;106(4):e1755–62.

    Article  PubMed  Google Scholar 

  48. Bureau UC. Income and Poverty in the United States 2018. Census.gov. https://www.census.gov/library/publications/2019/demo/p60-266.html. Accessed 1 May 2023.

    Google Scholar 

  49. Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev. 2019;35(2):e3097.

    Article  PubMed  Google Scholar 

  50. Powering greater Boston’s economy: why the Latino community is critical to our shared future. Boston Indicators. https://www.bostonindicators.org/reports/report-website-pages/latinos-in-greater-boston. Accessed 1 May 2023.

  51. Massachusetts Diabetes Data. Mass.gov. https://www.mass.gov/service-details/massachusetts-diabetes-data. Accessed 1 May 2023.

  52. Coronavirus-positive case rate is 3 times higher for Black and Latino populations, Massachusetts COVID-19 health equity advisory group finds - masslive.com. https://www.masslive.com/coronavirus/2020/06/coronavirus-positive-case-rate-is-3-times-higher-for-black-and-latino-populations-massachusetts-covid-19-health-equity-advisory-group-finds.html. Accessed 1 May 2023.

  53. Figueroa JF, Wadhera RK, Lee D, Yeh RW, Sommers BD. Community-level factors associated with racial and ethnic disparities in COVID-19 rates in Massachusetts. Health Aff Proj Hope. 2020;39(11):1984–92.

    Article  Google Scholar 

  54. Wiltz JL, Feehan AK, Molinari NM, Ladva CN, Truman BI, Hall J, et al. Racial and ethnic disparities in receipt of medications for treatment of COVID-19 - United States, March 2020-August 2021. MMWR Morb Mortal Wkly Rep. 2022;71(3):96–102.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Pischel L, Walelo M, Benson J, Osborn R, Schrier R, Tuan J, et al. Race and ethnicity do not impact eligibility for remdesivir: a single-center experience. PloS One. 2021;16(5):e0250735.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Rodríguez JE, Campbell KM. Racial and ethnic disparities in prevalence and care of patients with type 2 diabetes. Clin Diabetes Publ Am Diabetes Assoc. 2017;35(1):66–70.

    Article  Google Scholar 

  57. Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, et al. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics. 2015;135(3):424–34.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Shaw RJ, Pickett KE. The health benefits of Hispanic communities for non-Hispanic mothers and infants: another Hispanic paradox. Am J Public Health. 2013;103(6):1052–7.

    Article  PubMed  PubMed Central  Google Scholar 

  59. How has Boston gotten away with being segregated for so long? https://www.bostonmagazine.com/news/2020/12/08/boston-segregation/. Accessed 1 May 2023.

  60. August 7, Comments 2017 | Marisol Medina-Cadena |. La Cultura Cura: how Latinos are reclaiming their ancestral diets. Smithsonian Center for Folklife and Cultural Heritage. https://folklife.si.edu/talkstory/la-cultura-cura-how-latinos-are-reclaiming-their-ancestral-diets. Accessed 1 May 2023.

  61. Yeager K, Bauer-Wu. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013;26(4):1–2.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Nicole Taikeff and Angela Achkar contributed equally to this manuscript and should be considered as first co-authors.

Authors and Affiliations

  1. Division of Clinical Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Nicole Taikeff

  2. Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Angela Achkar

  3. Division of Internal Medicine, St. Elizabeth’s Medical center, Tufts Medical School and Boston University Medical School, Brighton, MA, 02135, USA

    Elie Naous

  4. Joslin Diabetes Center, Harvard Medical School, Boston, MA, 02215, USA

    Joanna Mitri

Authors
  1. Nicole Taikeff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela Achkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elie Naous
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joanna Mitri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in drafting the manuscript and all have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Angela Achkar.

Ethics declarations

Ethics Approval

Not applicable

Consent to Participate

Not applicable

Consent for Publication

Not applicable

Conflicts of Interest

Drs. Taikeff, Achkar, and Naous have no relevant financial or non-financial interest to disclose. Dr. Mitri reported grants from Novo Nordisk and Lilly for consulting, Dairy council for research and consulting, and NIDDk and KOWA for research.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taikeff, N., Achkar, A., Naous, E. et al. Unspoken Consequences of Structural Racism in the USA: Diabetes and COVID-19. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01722-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-023-01722-2

Keywords

Search

Navigation