Diabetes Fueling Racial, Economic Health Disparities in New York City

Diabetes continues to rise in New York City, the Health Department warned in a new report today, consigning tens of thousands of New Yorkers to possible disability and early death, and also fueling racial and economic disparities in health. The new report, Diabetes Among New York City Adults, finds that 9.1% of adult New Yorkers carried the diagnosis in 2007 — an increase of 13%, or 68,000 cases, since 2002.

The recognized citywide rate now significantly exceeds the national rate (7.5%) and threatens to climb even higher. An estimated 200,000 New Yorkers have undiagnosed diabetes. Some 23% have blood-sugar levels that place them on the borderline, and more than half of adult New Yorkers are overweight or obese — conditions that greatly increase the risk of diabetes.

“Diabetes is the fifth leading cause of death in New York City and it contributes to other leading causes of death,” said Dr. Thomas Farley, New York City Health Commissioner. “The consequences of uncontrolled diabetes are devastating, and can result in heart attack, stroke, kidney failure, blindness, nerve damage and amputations. New Yorkers at risk of diabetes should get screened for the disease. And people living with diabetes can work with their doctors to keep it under control.”

The report finds that diabetes prevalence varies according to sex, ethnicity, neighborhood and socioeconomic status. Men are more likely than women to have diabetes (10% versus 8%), and the disease is more common among New Yorkers with lower levels of education. In addition, diabetes disproportionately affects the poorest neighborhoods in the city. Diabetes death rates are higher among blacks and Hispanics than they are among white and Asian adults. Differences in diabetes death rates between blacks and whites persist regardless of neighborhood income, with blacks more than twice as likely as whites in the richest parts of the city, to die from diabetes.

Neighborhood income was also found to be a strong predictor of diabetes death among white, black and Hispanic New Yorkers, with residents in the poorest communities suffering the highest mortality. The report finds no such disparity among Asians, who experience similar mortality rates regardless of income. But diabetes prevalence is rising faster among Asians than among other groups, and the study finds that Asian adults are more likely than others to have elevated blood sugar levels that place them perilously close to diabetes. This condition, known as pre-diabetes, affects 34% of Asian adults in New York City, versus 22% of other adults.

Depression among adults with diabetes

The report notes a correlation between diabetes and a history of depression, particularly among middle-aged and older women. New York City adults with diabetes are twice as likely as those without diabetes to report ever suffering from depression (29% versus 14%). Among adults living with diabetes, a history of depression is 61% more likely among women than men; the gap is even wider (23% versus 8%) among those 65 and older.

Role of the Health Department

The Health Department is working to address diabetes and obesity in New York City. Key initiatives implemented in the past year include requiring chain restaurants to post calorie counts, maintaining a citywide registry of blood sugar readings to help physicians improve diabetes care, and expanding access to fresh fruits and vegetables in underserved neighborhoods. While these efforts will take time to affect the prevalence of diabetes and obesity in New York City, the Department continually monitors these initiatives and proactively explores new ways to address these epidemics.

Recommendations to help prevent and control diabetes:

Besides documenting the rise in diabetes, the new Health Department study offers recommendations for diabetes prevention, such as healthful eating, regular exercise and weight control. These measures are especially critical for people with pre-diabetes.

• Avoiding sugar-sweetened beverages
• Planning for at least 30 minutes of moderate physical activity on most or all days of the week
• Maintaining a healthy weight—even modest weight loss can help prevent diabetes
• Getting regularly screened by a health care provider for obesity, blood pressure and depression
• Routinely monitoring blood sugar level, blood pressure and cholesterol among adults living with diabetes. Adults with diabetes should not smoke.

Source: New York City Department of Health and Mental Hygiene