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

• 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
• Journal Title: BMJ OPEN DIABETES RESEARCH & CARE
• Volume: Volume 9, Number SUPPL_1
• Publisher: BMJ PUBLISHING GROUP | 2021-12-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjdrc-2021-002524
• Subjects: Health Sciences, Public Health; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; diabetes mellitus; type 2; HEALTH; MORTALITY; CARE

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.