One of the concerns in the health system should be to ensure that all people have an equal opportunity to receive adequate health care. There has been a building body of research on racial and other disparities in health care. A new study carried in JAMA examines whether the incidence of Type 2 diabetes in middle adulthood exhibits racial disparities and, if so, what factors may be responsible. (JAMA Article) The data comes from a 30 year study of about 5115 adults, of whom around 4250 had sufficient information for this analysis and about half of whom were African-Americans. There is in fact, as shown in prior studies, significantly greater incidence of Type 2 diabetes among black adults than Caucasian ones. A very large amount of physical, mental, socioeconomic and sociodemographic information was collected and tracked on the study subjects over the study period. This included information which relates to known risk factors for diabetes, such as diet and exercise. All this data allowed for extensive testing of various factors for the relationship with diabetes.
Among this study population, there was about an 80% greater incidence of Type 2 diabetes for the black adults. This notably greater risk was stronger for African-American women than men, but very substantial for both genders. But, after adjusting for biological factors, which included body mass index, blood pressure, lipid levels and certain other measures, there was no difference in risk. Psychosocial and the other tracked factors appeared to play a secondary role in incidence differences. Some of the difference in biological risk was present at the start of the study, the rest developed over the study period. In regard to biological factors, these are largely due to behavior, especially poor diet, poor exercise habits, more smoking, more alcohol use, etc. So to change the incidence of diabetes among African-Americans, behavior has to change, no excuses. But currently there are no incentives or penalties in place that would encourage such behavior change. So don’t expect a change in incidence. Although it is clearly a minor factor, the authors suggest that changing socio-economic disparities may also help reduce diabetes incidence. But, alas, those disparities are also often linked to individual behaviors, like failure to make an effort in school. An emphasis on self-responsibility, along with rights, would be the most powerful tool to create greater equality. But for some bizarre reason, it is not today politically correct to notice this obvious fact, even though the syndrome of poor behaviors affects all races.