Racial and Ethnic Differences in Perceived Diabetes Risk and Reasons for Perceived Risk: A Cross-Sectional Study

Given rising diabetes prevalence in the USA, especially among minoritized communities, it is critical to understand perception of diabetes risk and risk factors in the general population and in subpopulations known to be at increased risk for diabetes.

We aimed to describe overall and cause-specific perceived diabetes risk, especially racial and ethnic differences in perceived risk.

Cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, during which years the survey asked participants whether they believed they were at risk for diabetes, and if so, for what reason(s).

Adult participants in the NHANES without diagnosed diabetes.

Self-reported race or ethnicity, as well as educational attainment and glycemic status, was examined as primary exposures. The primary outcomes examined were rates of overall and cause-specific perceived diabetes risk, in strata of race or ethnicity and either educational attainment or glycemic status.

Compared to non-Hispanic White (NHW) participants, perceived diabetes risk was higher among Mexican-American and Other/Multi-Racial participants and lower among non-Hispanic Asian (NHA) participants. Perceived race-related diabetes risk was higher in all minoritized groups. Perceived overall, family history-related, and race-related risk increased with increasing educational attainment among minoritized but not NHW participants, and with knowledge of pre-diabetes status among all groups (24% perceived risk if normoglycemia, 69% if known pre-diabetes). Family history was the most frequently reported cause for perceived diabetes risk in all groups. In adjusted analyses, race and ethnicity were strongly associated with perceived race-related diabetes risk.

Compared to NHW individuals, US adults of any other race or ethnicity perceived higher race-related diabetes risk, increasing with educational attainment. Further research is needed to explore the impact of this perceived risk on physical and mental health outcomes and health behaviors.