City-Level Data Shows Stark Racial Disparities in Diabetes Deaths

In all 30 of the largest cities in the US, there are significant racial disparities in diabetes mortality rates, according to a study of city-level data published in Diabetes Research and Clinical Practice.

The study showed that diabetes mortality rates are higher among black individuals than whites in all 30 cities, and diabetes mortality inequities are four times larger in some cities compared to others.

Additionally, only three of the 30 largest cities had low rates of diabetes mortality and inequity, and Washington, DC had the highest rates of diabetes mortality inequities of all 30 cities.

According to NIH, diabetes affects 34.2 million people nationwide, with millions more who are likely undiagnosed. Examining data at a city level can inform more targeted policy interventions and programming to promote health equity, particularly within cities with the greatest inequities, researchers noted.

“Most studies do look at the US overall, but that can hide these nuances and differences that exist across cities,” said Joanna Buscemi, a psychologist of DePaul University and lead author of the study.

Researchers examined city-level data from two five-year time periods. The results showed that 22 of the 30 largest US cities had higher diabetes mortality rates than the US overall. The cities with the highest diabetes mortality rates were El Paso, Texas; Memphis, Tennessee; and Baltimore, Maryland.

The team also found that some cities fare worse than others when it comes to racial inequity. Researchers observed the worst disparity in Washington, DC, where black residents were almost seven times more likely to die of diabetes than their white neighbors.

In several cities, those inequities are increasing, including Chicago, Los Angeles, and Oklahoma City. The results showed bright spots in Louisville and Phoenix, which showed a statistically significant decrease in diabetes mortality racial inequities over time.

The team noted that black Americans are currently suffering greater mortality rates from COVID-19, and they also suffer from diabetes at higher rates than whites.

“The COVID-19 pandemic has increased awareness about racial health disparities in the US,” said Buscemi.

Researchers stated that improving policies and conditions that impact people with diabetes could help these same individuals if they do contract COVID-19. For example, placing a cap on the cost of insulin is something that could make a big difference quickly.

 “If you can’t afford insulin, and your disease is not managed, then it’s going to have more of an impact if you contract COVID,” Buscemi said.

Additionally, researchers said that addressing income inequality, affordable healthcare, food deserts, and having places to safely exercise could help reduce diabetes mortality disparities.

Researchers from DePaul and Sinai Urban Health Institute are engaging with community leaders, members, and organizations in research and action to assess and address health and social inequities. The team expects that this work will help close gaps in care and improve outcomes for underserved populations.

“DePaul faculty have broad expertise across disease presentations, and with Sinai Urban Health Institute’s experience working with communities to combat inequities in Chicago and nationally, it is a perfect partnership to tackle systems that perpetuate racial inequities,” Buscemi concluded.

Recent efforts in the research sector have aimed to eliminate health disparities. A new initiative called the Risk Underlying Rural Areas Longitudinal (RURAL) cohort study is working to address critical gaps in knowledge of heart and lung disorders in rural counties in the southeastern US.

“There are some health disparities that persist among Americans living in rural settings,” Peter Durda, PhD, Faculty Scientist at the Larner College of Medicine at the University of Vermont and co-investigator of the study, told HealthITAnalytics in an interview.

“Forty-six million people in the US are living in rural settings – that's one in six. We wanted to look at ten different counties in the rural South. These counties are matched based on socioeconomic status and general health, but their health outcomes are drastically different. Looking at these counties, we're hoping that we can have some insight into what the issues are with rural health, and understand how to help these people live better, longer lives.”