Time to start addressing (and not just describing) the social determinants of diabetes: results from the NEXT-D 2.0 network

• Type of Material: Article
• Authors: Karen Siegel, Emory University; Edward W Gregg, Imperial College London; Obidiugwu Kenrik Duru, University of California Los Angeles; Lizheng Shi, Tulane University; Carol M Mangione, University of California Los Angeles; Pamela L Thornton, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda; Steve Clauser, Patient-Centered Outcomes Research Institute; Mohammed Ali, Emory University
• Language: English
• Date: 2021-12-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjdrc-2021-002524
• Title of Journal or Parent Work: BMJ OPEN DIABETES RESEARCH & CARE
• Volume: 9
• Issue: SUPPL_1
• Grant/Funding Information: US Department of Health and Human Services, Centers for Disease Control and Prevention (grant number U18DP006535).
• Keywords: HEALTH; Endocrinology & Metabolism; Life Sciences & Biomedicine; MORTALITY; type 2; Science & Technology; diabetes mellitus; CARE
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Social determinants of health (SDOH) are not new. For example, observational data over 40 years have shown consistent—and often heart-wrenching—differences in diabetes outcomes across populations, where populations at socioeconomic disadvantage, in terms of lower education and income levels, experience less access to care and preventive services,1 lower rates of diagnosis, poorer health behaviors and control,2 worse cardiometabolic outcomes,3 and shorter life expectancy as compared with more advantaged populations of higher socioeconomic status.4 These findings suggest that diabetes is not a purely biological issue; its onset and progression are heavily influenced by the broader social context. In particular, type 2 diabetes is in large part the result of choices that people are unable to make based on the health-promoting resources and opportunities available and accessible to them.5 In in the USA, social and economic stressors and related disparities are patterned by geography and race/ethnicity.6 Type 2 diabetes, therefore, is as much an issue of where you live, as it is an issue of how you live.