The Role Of Socioeconomic Status In Racial/Ethnic Disparities In Complications Of Diabetes: The Atherosclerosis Risk In Communities Study

Background: Few prospective studies have evaluated the role of socioeconomic status in explaining racial/ethnic disparities across major complications among adults with diabetes. We assessed the prospective association of race/ethnicity with long-term complications and cardiovascular mortality in persons with diabetes in a community-based cohort. Methods: We conducted a prospective analysis of 4,460 black and white participants in the ARIC Study with prevalent or incident diabetes (and no history of cardiovascular disease) followed from time of diabetes through 2018. We calculated incidence rates of major clinical outcomes (fatal coronary heart disease or myocardial infarction, heart failure, ischemic stroke, end stage renal disease, hospitalized peripheral artery disease [PAD], lower extremity amputation) using standard definitions in the ARIC Study. We used Cox regression to assess the associations of race/ethnicity with incident complications and cardiovascular mortality before and after adjustment for cardiovascular and socioeconomic factors. Results: The incidence rates (per 1,000 person-years) were higher for black vs. white adults with diabetes for heart failure (22.1 vs. 17.4), ischemic stroke (8.5 vs. 5.5), end stage renal disease (5.6 vs. 1.6), PAD (4.7 vs. 3.2), lower extremity amputation (2.9 vs. 1.0) and cardiovascular mortality (7.5 vs. 6.5). These associations remained significant after adjusting for age, sex, smoking, and hypertension (HRs 1.41 to 3.27), but - with the exception of ESRD - were largely attenuated after further adjusting for health insurance and socioeconomic variables ( Table ). Conclusions: Among adults with diabetes, the association of race/ethnicity with complications differs depending on the outcome. Socioeconomic disparities play a major role in explaining the differences between groups. Our findings suggest that eliminating economic and healthcare system disparities is important to address health equity and prevent complications in adults with diabetes.