Social Determinants of Daily Step Count in Young Adults With and Without Prediabetes and Type 2 Diabetes

Physical activity is critical for preventing and managing prediabetes (PreD) and type 2 diabetes (T2D) but may be impacted by social determinants of health (SDOH). Because identified SDOH among older adults may not generalize to other age groups, we examined associations between SDOH and daily step count among young adults, specifically both with and without PreD or T2D.

This cross-sectional secondary analysis of the All of Us Research Program's survey, medical records, and Fitbit data included 2407 participants aged 18-34 years. SDOH exposures included employment status, household income, education, insurance, health care discrimination, social support, loneliness, neighborhood social cohesion, and neighborhood disorder. Multivariable linear regression assessed relationships between average daily steps and SDOH; P < .05 was used to define significance.

The cohort (mean age = 29.2 y, 78.3% female) averaged 7413 (4655) daily steps. Participants with PreD/T2D had fewer daily steps than those without PreD/T2D (6619 [4330] vs 7468 [4671] steps). Among all participants, employment (b = 936, P ≤ .001), lower health care discrimination (b = 550, P = .007 [lowest vs highest quartile]), lower loneliness (b = 821, P ≤ .001 [lowest vs highest quartile]), and higher neighborhood social cohesion (b = 1001, P ≤ .001 [lowest vs highest quartile]) were each associated with higher steps. Counterintuitively, lower neighborhood disorder (b = -1027, P ≤ .001 [lowest vs highest quartile]) and completing some college (b = -521, P = .04 [vs high school equivalent]) were associated with lower steps. Health insurance and social support differed in associations between participants with versus without PreD/T2D.

Daily steps were lower among young adults with PreD/T2D and were associated with multiple SDOH.