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Journal of Urban Health

, Volume 91, Issue 5, pp 873–885 | Cite as

Racial Disparities in Diabetes Mortality in the 50 Most Populous US Cities

  • Summer RosenstockEmail author
  • Steve Whitman
  • Joseph F. West
  • Michael Balkin
Article

Abstract

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.

Keywords

Large cities Diabetes Mortality Race Disparities Economic inequality Segregation 

Notes

Acknowledgments

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.

Funding

This study was supported by a grant from the Michael Reese Health Trust, Roe Health Policy Fund.

References

  1. 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.
  2. 2.
    Kirk JK, D’Agostino RB Jr, Bell RA, et al. Disparities in HbA1c levels between African-American and non-Hispanic White adults with diabetes: a meta-analysis. Diabetes Care. 2006; 29(9): 2130–2136.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Levine DA, Allison JJ, Cherrington A, Richman J, Scarinci IC, Houston TK. Disparities in self-monitoring of blood glucose among low-income ethnic minority populations with diabetes, United States. Ethn Dis. 2009; 19(2): 97–103.PubMedGoogle Scholar
  4. 4.
    Chan KS, Gaskin DJ, Dinwiddie GY, McCleary R. Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care? Med Care. 2012; 50(8): 692–699.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Landrine H, Corral I. Separate and unequal: residential segregation and Black health disparities. Ethn Dis. 2009; 19(2): 179–184.PubMedGoogle Scholar
  6. 6.
    Baig AA, Wilkes AE, Davis AM, et al. The use of quality improvement and health information technology approaches to improve diabetes outcomes in African-American and Hispanic patients. Med Care Res Rev. 2010; 67(5 Suppl): 163S–197S.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007; 64(5 Suppl): 101S–56S.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Ma Y, Hebert JR, Manson JE, et al. Determinants of racial/ethnic disparities in incidence of diabetes in postmenopausal women in the U.S.: the Women’s Health Initiative 1993–2009. Diabetes Care. 2012; 35(11): 2226–2234.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996; 125(3): 221–232.PubMedCrossRefGoogle Scholar
  10. 10.
    Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011; 40(3): 804–818.PubMedCrossRefGoogle Scholar
  11. 11.
    Weil EJ, Curtis JM, Hanson RL, Knowler WC, Nelson RG. The impact of disadvantage on the development and progression of diabetic kidney disease. Clin Nephrol. 2010; 74(Suppl 1): S32–8.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Billimek J, Sorkin DH. Self-reported neighborhood safety and non-adherence to treatment regimens among patients with type 2 diabetes. J Gen Intern Med. 2012; 27(3): 292–296.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Drewnowski A, Darmon N. The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr. 2005; 82(1 Suppl): 265S–273S.PubMedGoogle Scholar
  14. 14.
    Candib LM. Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes. Ann Fam Med. 2007; 5(6): 547–556.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Nwobu CO, Johnson CC. Targeting obesity to reduce the risk for type 2 diabetes and other co-morbidities in African-American youth: a review of the literature and recommendations for prevention. Diab Vasc Dis Res. 2007; 4(4): 311–319.PubMedCrossRefGoogle Scholar
  16. 16.
    Orsi JM, Margellos-Anast H, Whitman S. Black-White health disparities in the United States and Chicago: a 15-year progress analysis. Am J Public Health. 2010; 100(2): 349–356.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 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. 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. 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. 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. 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. 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. 23.
    Hoyert DL, Heron MP, Murphy SL, Kung HC. Deaths: final data for 2003. Natl Vital Stat Rep. 2006;54(13).Google Scholar
  24. 24.
    Gebreab SY, Diez Roux AV. Exploring racial disparities in CHD mortality between Blacks and Whites across the United States: a geographically weighted regression approach. Health Place. 2012; 18(5): 1006–1014.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 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. 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. 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.
  28. 28.
    Whitman S, Orsi J, Hurlbert M. The racial disparity in breast cancer mortality in the 25 largest cities in the United States. Cancer Epidemiol. 2012; 36(2): e147–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont, CA: Lifetime Learning; 1982: 296–299.Google Scholar
  30. 30.
    Gamble VN, Stone D. U.S. policy on health inequities: the interplay of politics and research. J Health Polit Policy Law. 2006; 31(1): 93–126.PubMedCrossRefGoogle Scholar
  31. 31.
    StataCorp. Stata Statistical Software: Release 12. 2011;College Station, TX: StataCorp LP.Google Scholar
  32. 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.
  33. 33.
    Massey DS, Denton NA. Hypersegregation in U.S. metropolitan areas: Black and Hispanic segregation along five dimensions. Demography. 1989; 26(3): 373–391.PubMedCrossRefGoogle Scholar
  34. 34.
    Massey DS, Rothwell J, Domina T. The changing bases of segregation in the United States. Ann Am Acad Polit SS. 2009; 626: 74–90.CrossRefGoogle Scholar
  35. 35.
    Hilbe JM. Negative binomial regression. 2nd Edition ed. UK: University Press, Cambridge; 2011.CrossRefGoogle Scholar
  36. 36.
    Osborne NH, Upchurch GR Jr, Mathur AK, Dimick JB. Explaining racial disparities in mortality after abdominal aortic aneurysm repair. J Vasc Surg. 2009; 50(4): 709–713.PubMedCrossRefGoogle Scholar
  37. 37.
    Haas JS, Phillips KA, Sonneborn D, et al. Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual’s county of residence. Med Care. 2004; 42(7): 707–714.PubMedCrossRefGoogle Scholar
  38. 38.
    Haas JS, Earle CC, Orav JE, Brawarsky P, Neville BA, Williams DR. Racial segregation and disparities in cancer stage for seniors. J Gen Intern Med. 2008; 23(5): 699–705.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Benjamins MR, Kirby JB, Bond Huie SA. County characteristics and racial and ethnic disparities in the use of preventive services. Prev Med. 2004; 39(4): 704–712.PubMedCrossRefGoogle Scholar
  40. 40.
    White K, Haas JS, Williams DR. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res. 2012; 47(3 Pt 2): 1278–1299.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Small ML. Neighborhood institutions as resource brokers: childcare centers, interorganizational ties, and resource access among the poor. Soc Probl. 2006; 53(2): 274–292.CrossRefGoogle Scholar
  42. 42.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009; 32(1): 20–47.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001; 116(5): 404–16.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003; 93(2): 215–21.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80-94.Google Scholar

Copyright information

© The New York Academy of Medicine 2014

Authors and Affiliations

  • Summer Rosenstock
    • 1
    • 3
    Email author
  • Steve Whitman
    • 1
  • Joseph F. West
    • 1
  • Michael Balkin
    • 2
  1. 1.Sinai Urban Health InstituteSinai Health SystemChicagoUSA
  2. 2.Chicago Medical SchoolChicagoUSA
  3. 3.ChicagoUSA

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