Racial Disparities in Diabetes Mortality in the 50 Most Populous US Cities
- 666 Downloads
While studies have consistently shown that in the USA, non-Hispanic Blacks (Blacks) have higher diabetes prevalence, complication and death rates than non-Hispanic Whites (Whites), there are no studies that compare disparities in diabetes mortality across the largest US cities. This study presents and compares Black/White age-adjusted diabetes mortality rate ratios (RRs), calculated using national death files and census data, for the 50 most populous US cities. Relationships between city-level diabetes mortality RRs and 12 ecological variables were explored using bivariate correlation analyses. Multivariate analyses were conducted using negative binomial regression to examine how much of the disparity could be explained by these variables. Blacks had statistically significantly higher mortality rates compared to Whites in 39 of the 41 cities included in analyses, with statistically significant rate ratios ranging from 1.57 (95 % CI: 1.33–1.86) in Baltimore to 3.78 (95 % CI: 2.84–5.02) in Washington, DC. Analyses showed that economic inequality was strongly correlated with the diabetes mortality disparity, driven by differences in White poverty levels. This was followed by segregation. Multivariate analyses showed that adjusting for Black/White poverty alone explained 58.5 % of the disparity. Adjusting for Black/White poverty and segregation explained 72.6 % of the disparity. This study emphasizes the role that inequalities in social and economic determinants, rather than for example poverty on its own, play in Black/White diabetes mortality disparities. It also highlights how the magnitude of the disparity and the factors that influence it can vary greatly across cities, underscoring the importance of using local data to identify context specific barriers and develop effective interventions to eliminate health disparities.
KeywordsLarge cities Diabetes Mortality Race Disparities Economic inequality Segregation
We would like to thank the Michael Reese Health Trust, Roe Health Policy Fund for supporting this research, and Jay Herson for his support and technical assistance.
This study was supported by a grant from the Michael Reese Health Trust, Roe Health Policy Fund.
- 1.CDC. CDC - 2011 National Estimates - 2011 National Diabetes Fact Sheet—Publications—Diabetes DDT. Available at: http://www.cdc.gov/DIABETES//pubs/estimates11.htm. Accessed 19 March 2013.
- 17.US Department of Health and Human Services, Office of Minority Health. Diabetes and African-Americans. Updated: August 2012; Available at: http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3017. Accessed 19 March 2013.
- 18.Johns Hopkins Urban Health Institute. Health disparities in Baltimore City: is geography destiny? Available at: http://urbanhealth.jhu.edu/media/reports/healthdis_baltimore.pdf. Accessed 4 April 2013.
- 19.Karpati A, Kerker B, Mostashari F, et al. Health Disparities in New York City. 2004; Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Other/2004/Jul/Health%20Disparities%20in%20New%20York%20City/Karpati_disparities%20pdf.pdf. Accessed 4 April 2013.
- 20.Houston Department of Health and Human Services. The City of Houston Health Disparities Data Report. Updated: March 2008; Available at: http://www.houstontx.gov/health/disparity.pdf. Accessed 4 April 2013.
- 21.Whitman S, Shah AM, Benjamins MR, eds. Urban health: combating disparities with local data. New York, NY: Oxford University Press; 2011.Google Scholar
- 22.U.S. Census Bureau. 2005–2007 American Community Survey. Available at: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#. Accessed 30 Janaury 2012.
- 23.Hoyert DL, Heron MP, Murphy SL, Kung HC. Deaths: final data for 2003. Natl Vital Stat Rep. 2006;54(13).Google Scholar
- 25.Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998; 47(3): 1–16. 20.Google Scholar
- 26.Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. Natl Vital Stat Rep. 2010;58(19).Google Scholar
- 27.U.S. Census Bureau. 2000 Census. Available at: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#. Accessed 30 January 2012.
- 29.Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont, CA: Lifetime Learning; 1982: 296–299.Google Scholar
- 31.StataCorp. Stata Statistical Software: Release 12. 2011;College Station, TX: StataCorp LP.Google Scholar
- 32.US 2010. Residential segregation data: exposure and isolation indices based on 2005–2009 ACS census data. Available at: http://www.s4.brown.edu/us2010/Data/Download1.htm. Accessed 21 July 2012.
- 45.Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80-94.Google Scholar