SUN-840 - A 16-Year Evaluation of Socioeconomic Differences in Diabetes Among 570,000 U.S. Adults

Objective:
Understanding how racial/ethnic and socioeconomic factors influence diabetes diagnosis, and whether disparities have changed over time, is essential for developing equitable public health interventions. We aimed to evaluate differences in diabetes diagnosis by race/ethnicity, education, and income among U.S. adults from 2008 to 2024 and assess whether these associations changed over time.

Methods: Repeated cross-sectional analysis of pooled National Survey on Drug Use and Health data (2008–2024). Participants were non-institutionalized U.S. adults aged ≥ 18 years. After excluding duplicates and missing data, the analytic sample included 570,953 adults (weighted sample size: 192,288,972). Exposures were evaluated as self-reported race/ethnicity (non-Hispanic White [NHW; reference], Black/African American, Asian, Other, Hispanic), education (less than high school [reference], high school, some college/associate, college or higher), family income ( < $20 000 [reference], $20 000–$49 999, $50 000–$74 999, ≥ $75 000), and survey year (mean-centered), with interactions for each sociodemographic variable. The main outcome was self-reported diabetes diagnosis (yes/no). Survey-weighted logistic regression estimated adjusted odds ratios (ORs) for sociodemographic predictors and their interactions with year.

Results: Diabetes prevalence was 12.41%. Compared with NHW adults, odds of diabetes were higher among Asian (OR = 1.54; 95% CI 1.29–1.83), Black/African American (OR = 1.67; 1.52–1.83), Hispanic (OR = 1.65; 1.51–1.81), and Other (OR = 1.65; 1.36–1.96) groups (all ps < .001). Higher income (≥ $75 000; OR = 0.78; 0.71–0.86) and college education (OR = 0.72; 0.65–0.80) were protective (both ps < .001). Annual diabetes odds increase 5.9% among NHW, 4.8% Other races, 4.3% Hispanic, 3.7% for Asian, and 3.4% for Black/African American adults. Slope comparisons showed significantly steeper increases among NHW than among Asian (p = .033), Black/African American (p < .001), and Hispanic (p = .003) participants. Income × year and education × year interactions were not significant (p = .776).
Conclusions and Relevance: Racial/ethnic and socioeconomic disparities in diabetes persist among U.S. adults, with differing temporal trends across racial/ethnic groups. Targeted policies addressing structural and social determinants of health remain important to reduce diabetes-related inequities.

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