Disparities in diabetes: the nexus of race, poverty, and place.
OBJECTIVE
We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalence.


METHODS
We used data from the 1999-2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial composition and poverty concentration on the odds of having diabetes.


RESULTS
We found a race-poverty-place gradient for diabetes prevalence for Blacks and poor Whites. The odds of having diabetes were higher for Blacks than for Whites. Individual poverty increased the odds of having diabetes for both Whites and Blacks. Living in a poor neighborhood increased the odds of having diabetes for Blacks and poor Whites.


CONCLUSIONS
To address race disparities in diabetes, policymakers should address problems created by concentrated poverty (e.g., lack of access to reasonably priced fruits and vegetables, recreational facilities, and health care services; high crime rates; and greater exposures to environmental toxins). Housing and development policies in urban areas should avoid creating high-poverty neighborhoods.
Darrell J. Gaskin, Roland J. Thorpe Jr, Emma E. McGinty, and Thomas A. LaVeist are with the Hopkins Center for Health Disparities Solutions and the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Kelly Bower is with the Hopkins Center for Health Disparities Solutions and the Department of Community Public Health, Johns Hopkins School of Nursing, Baltimore. Charles Rohde is with the Hopkins Center for Health Disparities Solutions and the Department of Biostatistics at the Johns Hopkins Bloomberg School of Public Health. J. Hunter Young is with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research in the Johns Hopkins School of Medicine, Baltimore. Lisa Dubay is with the Urban Institute, Washington, DC.
Darrell J
DJ
Gaskin
Roland J
RJ
Thorpe
Emma E
EE
McGinty
Kelly
K
Bower
Charles
C
Rohde
J Hunter
JH
Young
Thomas A
TA
LaVeist
Lisa
L
Dubay
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult