Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults.
Level 4 - case-series / case-control
Cross-sectional survey analysis of population data
PubMed 38164446 · doi:10.3389/fpubh.2023.1277657
What was done
A pooled cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data from 2011 to March 2020 evaluated 10,262 U.S. adults self-reporting as Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Awareness of prediabetes was categorized based on participant survey responses. Multivariable logistic regression models calculated adjusted prevalence ratios (PR) for prediabetes and prediabetes awareness according to race, ethnicity, and educational attainment, controlling for sociodemographic, healthcare-related, and clinical characteristics.
What was found
In fully adjusted models: - Prediabetes prevalence vs. White adults: Asian PR 1.26 (95% CI 1.18–1.35), Black PR 1.17 (95% CI 1.08–1.25), Hispanic PR 1.10 (95% CI 1.02–1.19). - Prediabetes prevalence vs. college graduates: Less than high school PR 1.14 (95% CI 1.02–1.26), high school PR 1.12 (95% CI 1.01–1.23). - Prediabetes awareness vs. White adults: Black PR 1.27 (95% CI 1.07–1.50), Hispanic PR 1.33 (95% CI 1.02–1.72). - Prediabetes awareness vs. college graduates: Less than high school PR 0.66 (95% CI 0.47–0.92).
Why it matters
While racial and ethnic minority groups have higher rates of prediabetes and higher awareness, adults with low educational attainment face both higher prediabetes risk and substantially lower awareness, highlighting key targets for diabetes prevention efforts.
Limits
The study is limited by its cross-sectional design, preventing causal inference. Awareness was determined via self-report, introducing potential recall or reporting bias. The sample excluded other racial and ethnic groups not captured in the four broad categories.