Racial and economic segregation and diabetes mortality in the USA, 2016-2020

Area of Science:

• Public Health
• Epidemiology
• Sociology

Background:

• Racial and economic segregation are persistent issues in the United States.
• Diabetes remains a leading cause of mortality with disparities in outcomes.
• Understanding the social determinants of health is crucial for targeted interventions.

Purpose of the Study:

• To investigate the association between racial and economic segregation and diabetes mortality.
• To analyze this relationship across US counties between 2016 and 2020.

Main Methods:

• A cross-sectional ecological study utilizing county-level data from the National Vital Statistics System and American Community Survey (n=2380).
• Racialized economic segregation measured using the Index Concentration at the Extremes (ICE) for income, race, and combined factors.
• Multilevel Poisson regression analysis to estimate adjusted mortality rates and risk ratios.

Main Results:

• Higher concentrations of low-income and non-Hispanic Black households were associated with greater diabetes mortality.
• Counties with the highest segregation (Q5) exhibited significantly increased diabetes mortality compared to the least segregated (Q1).
• Specific adjusted risk ratios (aRR) indicated elevated risks for ICE_income (1.96), ICE_race (1.32), and ICE_combined (1.70).

Conclusions:

• Racial and economic segregation is demonstrably associated with diabetes mortality.
• These findings underscore the impact of segregation on health outcomes at a county level.
• Addressing segregation may be a key strategy in reducing diabetes mortality disparities.