Demographic influences and health disparities in adults with diabetes

Abstract

Disparities in diabetes burden and outcomes can largely depend on factors related to peoples’ demographic influences, social and ecological conditions, and system-level factors-many of which are preventable in nature. In Unequal Treatment, the Institute of Medicine (IOM) emphasizes unacceptable causes of health disparities that stem from the health-care system, arguing that health-care contributions to health disparities should be systematically eliminated. The US Department of Health and Human Services has called for an even broader view of what determines health, highlighting the “determinants of health not only at the individual level but also in broader society that lay bare the unacceptable.” In this chapter, we will review important demographic factors that contribute to health disparities among patients with type 1 and type 2 diabetes, including age, sex and gender, race and ethnicity, and socioeconomic status. For each demographic factor, we will review differences in the incidence and prevalence of diabetes, disease-related outcomes, health-care access, and health-care quality received. We will then expand our perspective from individual-level demographic factors to examine intersectionality of key demographic factors, spatial contexts, and the socioecological role of place. Finally, we will review system-level factors in health care and the community and current efforts to address the multilevel determinants of diabetes disparities.