Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes

Abstract

There is strong evidence that race/ethnicity and social determinants of health significantly impact outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships/associations will improve development of cost-effective, culturally tailored programs for patients with diabetes. This article reviews the current state of the literature on the impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial/ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure, and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support, and perceived stress, show consistent associations with self-care, quality of life, and glycemic control. Neighborhood factors, such as food insecurity, social cohesion, and neighborhood aesthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Health care professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.

Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden

“…They include factors such as socioeconomic status, the physical environment, employment, and social support networks as well as access to health care . The distributions of economic and social conditions among the population are known to influence individual and group differences in health status . Deficiencies in these areas may disproportionately affect black patients …”

“…The distributions of economic and social conditions among the population are known to influence individual and group differences in health status . Deficiencies in these areas may disproportionately affect black patients …”

Social Determinants of Health and Racial/Ethnic Disparities in Type 2 Diabetes in Youth

“…Health disparities are usually defined as negative differences in health that are closely linked with social, economic, and environmental disadvantages [11]. Notably, there is increasing focus on the role of social determinants of health (SDOH) as a key cause of disparate health outcomes among minority adults with diabetes [12–14]. Social determinants of health are the conditions in which families live that can adversely influence health, such as low family socioeconomic status or neighborhood poverty.…”

1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2018

“…(54)(55)(56)(57)(58). Social determinants of health are defined as the economic, environmental, political, and social conditions in which people live and are responsible for a major part of health inequality worldwide (59).…”