Educational Disparities in the Prevalence of Diabetes and Prediabetes in the United States, 2001-2020 Restricted; Files Only

Choi, Ji Young (Spring 2023)

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This study aims to examine whether the prevalence of diabetes and prediabetes varied by education level and whether these patterns changed over the past two decades in the United States. Data were from adults aged 30 to 79 in the National Health and Nutrition Examination Survey, 2001-2020 (n=33,200). Diabetes was defined based on self-reported diagnosis of diabetes, elevated glycated hemoglobin (HbA1c≥6.5%) or the use of diabetes medications. Prediabetes was defined as HbA1c of 5.7-6.4%. We estimated the age-standardized prevalence of diabetes and prediabetes by educational attainment (less than high school, high school diploma and some college or higher) and survey period. Adjusted associations between educational attainment and diabetes and prediabetes were estimated using multiple logistic regression models. The prevalence of diabetes increased from 10.8% to 16.2% and prediabetes increased from 14.0% to 23.3% between 2001-2004 and 2017-2020. Less-educated adults consistently had a higher prevalence of diabetes and prediabetes than college-educated. The odds of having diabetes and prediabetes among those with less than high school were significantly higher than that of college-educated (diabetes: OR=1.37 [1.23-1.52]; prediabetes: OR=1.2 [1.1-1.3]). The absolute magnitude of disparity between adults with less than a high school education and the college-educated group was similar in 2001-2004 (3.9 percentage points) and 2017-2020 (4.3 percentage points). In conclusion, substantial disparities in diabetes by educational attainment were observed in the United States in 2001-2020, with evidence of unchanging magnitude of disparities over time. Therefore, novel intervention strategies focusing on diabetes prevention in individuals with lower educational attainment are urgently warranted.

Table of Contents

Chapter 1: Introduction 1

1.1 Introduction and Rationale 1

1.2 Problem Statement 2

1.3 Purpose Statement 3

Chapter 2: Comprehensive Review of the Literature 4

2.1 Definitions of Diabetes and Prediabetes 4

2.2 Trends in the Prevalence of Diabetes and Prediabetes 5

2.3 Socioeconomic Status (SES) and Diabetes and Prediabetes 6

2.4 Data Source - National Health and Nutrition Examination Survey 7

Chapter 3: Manuscript 9

Abstract 10

Introduction 11

Methods 12

Results 16

Discussion 19

Conclusion 23

References 24

Tables and Figures 32

Supplemental Figures and Tables 36

Chapter 4: Conclusion and Public Health Recommendations 39

Chapter 5: References 41

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