Structural Racism as an Upstream Social Determinant of Diabetes Outcomes: A Scoping Review

Egede, Leonard E.; Campbell, Jennifer A.; Walker, Rebekah J.; Linde, Sebastian

doi:10.2337/dci22-0044

Cited by 29 publications

(16 citation statements)

References 49 publications

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“…Associations between structural racism and cardiovascular health have been shown for discriminatory housing policies and continuing neighbourhood racial segregation 30,31 ; with the historical legacy of slavery 32 ; and with state-level institutional domains 33 . Associations have also been shown for diabetes outcomes in the US 34 and globally 35 .…”

Section: Introductionmentioning

confidence: 92%

An epigenome-wide analysis of DNA methylation, racialized and economic inequities, and air pollution

Watkins,

Testa,

Simpkin

et al. 2023

Preprint

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ImportanceDNA methylation (DNAm) provides a plausible mechanism by which adverse exposures become embodied and contribute to health inequities, due to its role in genome regulation and responsiveness to social and biophysical exposures tied to societal context. However, scant epigenome-wide association studies (EWAS) have included structural and lifecourse measures of exposure, especially in relation to structural discrimination.ObjectiveOur study tests the hypothesis that DNAm is a mechanism by which racial discrimination, economic adversity, and air pollution become biologically embodied.DesignA series of cross-sectional EWAS, conducted in My Body My Story (MBMS, biological specimens collected 2008-2010, DNAm assayed in 2021); and the Multi Ethnic Study of Atherosclerosis (MESA; biological specimens collected 2010-2012, DNAm assayed in 2012-2013); using new georeferenced social exposure data for both studies (generated in 2022).SettingMBMS was recruited from four community health centers in Boston; MESA was recruited from four field sites in: Baltimore, MD; Forsyth County, NC; New York City, NY; and St. Paul, MN.ParticipantsTwo population-based samples of US-born Black non-Hispanic (Black NH), white non-Hispanic (white NH), and Hispanic individuals (MBMS; n=224 Black NH and 69 white NH) and (MESA; n=229 Black NH, n=555 white NH and n=191 Hispanic).ExposuresEight social exposures encompassing racial discrimination, economic adversity, and air pollution.MainoutcomeGenome-wide changes in DNAm, as measured using the Illumina EPIC BeadChip (MBMS; using frozen blood spots) and Illumina 450k BeadChip (MESA; using purified monocytes). Our hypothesis was formulated after data collection.ResultsWe observed the strongest associations with traffic-related air pollution (measured via black carbon and nitrogen oxides exposure), with evidence from both studies suggesting that air pollution exposure may induce epigenetic changes related to inflammatory processes. We also found suggestive associations of DNAm variation with measures of structural racial discrimination (e.g., for Black NH participants, born in a Jim Crow state; adult exposure to racialized economic residential segregation) situated in genes with plausible links to effects on health.Conclusions and RelevanceOverall, this work suggests that DNAm is a biological mechanism through which structural racism and air pollution become embodied and may lead to health inequities.Key pointsQuestionCould DNAm be a mechanism by which adversity becomes embodied?FindingsTraffic-related air pollution exposure may induce epigenetic changes related to inflammatory processes and there are suggestive associations with measures of structural racismMeaningDNAm may be a biological mechanism through which structural racism and air pollution become biologically embodied

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Section: Introductionmentioning

confidence: 92%

An epigenome-wide analysis of DNA methylation, racialized and economic inequities, and air pollution

Watkins,

Testa,

Simpkin

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…4 Youth-onset T2DM disproportionately affects visible ethnic minorities living in poverty, 35 individuals in food insecure households, 36 and those exposed to structural racism. 37 Treatment recommendations should be individualized to consider the cultural, social, geographic and economic barriers to implementing behavioural change.…”

Section: Psychosocial Considerationsmentioning

confidence: 99%

Management of Pediatric Type 2 Diabetes

Basak

2023

Can Diabetes Endocrinol Today

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Type 2 Diabetes Mellitus (T2DM) can no longer be considered an adult chronic disease. The diagnosis of pediatric T2DM is based on the laboratory criteria of fasting plasma glucose ≥7.0 mmol/L; 2-hour plasma glucose on a 75 g oral glucose tolerance test (OGTT) ≥11.1 mmol/L; random plasma glucose ≥11.1 mmol/L; or A1c ≥6.5% per Diabetes Canada. It is important to note that these criteria are based on extrapolations from adult data, and have not been specifically validated in youth. The International Society for Pediatric and Adolescent Diabetes (ISPAD) adds that the diagnosis should not be made on these laboratory criteria alone, but should include symptoms of hyperglycemia and negative islet auto-antibodies. A Canadian national surveillance study of pediatric T2DM completed in 2010, has demonstrated a minimum incidence of youth-onset T2DM of 1.54 per 100,000 children per year with significant regional variation; the highest incidence was 12.45 per 100,000 children per year in Manitoba. Youth-onset T2DM disproportionately affected Canadian children from high-risk ethnic groups, with 44% of new diagnoses occurring in the Indigenous, Asian, African and Caribbean populations. Over the past twenty years, youth-onset diabetes has been rising. In the United States, according to the SEARCH for Diabetes in Youth Study, there has been an annual increase of 7.1% observed across all age, sex, race and ethnic groups. The COVID-19 pandemic has added further escalation in the incidence of youth-onset worsening disease severity at presentation. New cases in the United States rose by 77.3% in the initial year following the COVID-19 pandemic, vs in the two years pre-pandemic. Furthermore, 21% of youth presented with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome vs previous estimates of 9% pre-pandemic. The SEARCH for Diabetes in Youth Group projects that the number of youths with T2DM will increase from 28,000 to 48,000 youth today, to 220,000 youth by 2060, with widening racial and ethnic disparities among youth with T2DM

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“…Differences in social determinants of health are therefore the result of these structural factors, which exist antecedent to the social risks known to impact health outcomes. 7,8 Therefore, the convergence of structural inequalities, structural racism, and social determinants of health creates social risks, which impact the health of specific populations and result in health disparities. 9 This perspective offers insight on how we got here, the consequences of our current state, and thoughts on a way forward that focus on improving health outcomes for the entire US population.…”

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confidence: 99%

Addressing Structural Inequalities, Structural Racism, and Social Determinants of Health: a Vision for the Future

Egede,

Walker,

Williams

2023

J GEN INTERN MED

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Significant national discourse has focused on the idea of structural inequalities and structural racism within a variety of societal sectors, including healthcare. This perspective provides an understanding of the historic and pervasive nature of structural inequalities and structural racism; uses well-known frameworks in health equity research for conceptualizing structural inequality and structural racism; offers a summary of the consequences of structural inequalities and structural racism on modern-day health outcomes; and concludes with strategies and suggestions for a way forward. Recommended strategies across different sectors of influence include (a) employment and economic empowerment sector: creating capacity for individuals to earn livable wages; (b) education sector: developing new funding structures to ensure equal opportunities are offered to all; (c) healthcare sector: prioritizing universal access to high-quality health care, including mental health treatment; (d) housing sector: improving access to affordable, safe housing through public-private partnerships; (e) criminal justice sector: focusing reform on restorative justice that is people-centric instead of punitive; and (f) environmental sector: creating sustainable systems that alleviate downstream consequences of climate change. The recommended strategies account for the mutually reinforcing and pervasive nature of structural inequalities/structural racism and target key sectors of influence to enhance overall health outcomes and achieve equity regardless of race, ethnicity, or socioeconomic status.

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Structural Racism as an Upstream Social Determinant of Diabetes Outcomes: A Scoping Review

Cited by 29 publications

References 49 publications

An epigenome-wide analysis of DNA methylation, racialized and economic inequities, and air pollution

An epigenome-wide analysis of DNA methylation, racialized and economic inequities, and air pollution

Management of Pediatric Type 2 Diabetes

Addressing Structural Inequalities, Structural Racism, and Social Determinants of Health: a Vision for the Future

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