Hispanic Americans have the highest racial/ethnic prevalence of diabetes, while diabetes prevalence is similar in Asian and black Americans, according to a nationally representative study in The Journal of the American Medical Association.
The study included data on 7575 US adults aged 20 years or older (mean 47.5) from the National Health and Nutrition Examination Surveys 2011–16. Participants were asked if they had been diagnosed with diabetes by a physician; undiagnosed diabetes was assessed by measurement of hemoglobin A1c, tasting plasma glucose, or 2-hour fasting plasma glucose. Racial/ethnic differences in diabetes prevalence were assessed, including selected subgroups within the Hispanic and Asian populations.
Sixty-five percent of participants were non-Hispanic white, 15% Hispanic, 11% non-Hispanic black, 6% non-Hispanic Asian, and 3% other race/ethnicity. Crude prevalence of diabetes was 14.6% overall, including diagnosed diabetes in 10.0% of participants and undiagnosed diabetes in 4.6%. Another 37.5% of participants had prediabetes. There were significant racial/ethnic variations in age, body mass index, and education.
After adjustment for age and sex, weighted total diabetes prevalence was 12.4% for white adults compared to 22.1% for Hispanic, 20.4% for black, and 19.1% for Asian adults. Within the Hispanic population, total diabetes prevalence was 24.6% for the Mexican, 21.7% for Puerto Rican, 20.5% for Cuban/Dominican, 19.3% for Central American, and 12.3% for South American subgroups. Prevalence was 22.4% for Southeast Asian, 22.3% for South Asian, and 14.0% for East Asian subgroups.
Non-white racial/ethnic groups had higher prevalences of undiagnosed diabetes: 3.9% for white, 5.2% for black, and 7.5% for both Hispanic and Asian Americans. A high percentage of cases of undiagnosed diabetes were identified by 2-hour fasting plasma glucose.
Hispanic and Asian individuals now account for 23% of the US population. Both of these racial/ethnic groups have been reported to have a higher prevalence of diabetes compared with European and African populations. The new study of racial/ethnic differences includes current, nationally representative estimates of diabetes prevalence among Hispanic and Asian adults.
The results suggest that Hispanic Americans have the highest total prevalence of diabetes. Asian and black Americans also have increased diabetes prevalence, compared to their white counterparts.
The study also identifies differences in prevalence among Hispanic and Asian population subgroups. The researchers suggest that racial/ethnic differences in undiagnosed diabetes might be related to underlying physiologic causes [Cheng YJ, et al. Prevalence of diabetes by race and ethnicity in the United States, 2011–2016. JAMA 2019; 322:2389–2398].