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Original research
Racial and economic segregation and diabetes mortality in the USA, 2016–2020
  1. Ryan Saelee1,
  2. Dayna S Alexander1,
  3. Jacob T Wittman1,
  4. Meda E Pavkov1,
  5. Darrell L Hudson2,
  6. Kai McKeever Bullard1
  1. 1 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Brown School at Washington University, St. Louis, Missouri, USA
  1. Correspondence to Dr Ryan Saelee; rsaelee{at}cdc.gov

Abstract

Background The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.

Methods We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016–2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.

Results Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICEincome), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICErace) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICEcombined) had greater diabetes mortality.

Conclusion Racial and economic segregation is associated with diabetes mortality across US counties.

  • DIABETES MELLITUS
  • Health inequalities
  • SOCIAL CLASS
  • ETHNIC GROUPS
  • POVERTY

Data availability statement

Data are available in a public, open access repository. Data are publicly available from the US Census Bureau (https://data.census.gov/) and CDC WONDER (https://wonder.cdc.gov/) websites.

https://doi.org/10.1136/jech-2024-222178

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    Data availability statement

    Data are available in a public, open access repository. Data are publicly available from the US Census Bureau (https://data.census.gov/) and CDC WONDER (https://wonder.cdc.gov/) websites.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The ICEincome, ICErace and ICEcombined in the Results section of the Abstract have been corrected to match table 3.

    • Contributors RS, DSA, JTW, MEP, DLH and KMB were involved in the conception, design and conduct of the study and the interpretation of the results. RS conducted statistical analysis and wrote the first draft of the manuscript, and all authors edited, reviewed and approved the final version of the manuscript. RS is the guarantor of this work and, as such, had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.