ArticleJournal of racial and ethnic health disparities2026
Racial and Ethnic Differences in Diabetes Treatment Modality Selection: The Role of Income and Sociodemographic Factors in NHANES 2017-2023, A Cross-Sectional Study.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Racial and ethnic disparities in diabetes prevalence and outcomes are well documented; however less is known about whether the selection of treatment modality itself differs across racial groups after adjustment for clinical correlates of disease severity. This cross-sectional analysis used National Health and Nutrition Examination Survey (NHANES) data from the 2017-March 2020 and August 2021-August 2023 cycles. The primary analytical sample comprised 1,688 adults aged 18 years and older with physician-confirmed diabetes, after excluding 46 probable Type 1 cases. Treatment modality was categorized as insulin-only, oral medication-only (base outcome), combination therapy, or no medication, based on self-reported use of insulin and oral antidiabetic medications. Survey-weighted multinomial logistic regression adjusted for age, gender, education, income, birthplace, insurance, HbA1c, body mass index (BMI), and self-reported diabetes duration. Race and ethnicity remained a significant overall predictor of treatment modality after full adjustment (joint Wald p = 0.012). Other/Multi-Racial adults had 57% lower relative risk of insulin-only therapy than Non-Hispanic White (NHW) adults (relative risk ratio [RRR] = 0.43, 95% CI: 0.24-0.76, p = 0.005), and Other Hispanic and Other/Multi-Racial adults had lower relative risk of combination therapy (RRR = 0.56, p = 0.034 and RRR = 0.47, p = 0.043, respectively). Non-Hispanic Black (NHB) adults did not differ from NHWs at the population level. HbA1c, diabetes duration, BMI, and insurance status were the strongest predictors of treatment modality. An exploratory race-by-income interaction model produced a non-significant joint test (p = 0.259) and is reported as hypothesis-generating. Differences in modality use persist after adjustments, suggesting that structural and healthcare-system factors may contribute to treatment variation independently of measured clinical and socioeconomic characteristics.
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