Diabetes more common in low-income middle-aged people, rising among higher-income group

Diabetes has been on the rise among higher-income middle-aged adults, as have disparities between income groups in treatment rates, a study found.

The serial cross-sectional study used data from the National Health and Nutrition Examination Surveys in 1999 to 2020 on 20,761 Americans ages 40 to 64 years. It found that the prevalence of diabetes and obesity was consistently higher among low-income adults. However, while neither condition changed significantly in this group over the study period, higher-income adults had increases in both diabetes (from 7.8% to 14.9%) and obesity (from 33.0% to 44.0%). Diabetes treatment rates improved from 1999 to 2020 only among the higher-income group (58.4% to 77.4%). In addition, income-based disparities in diabetes incidence persisted over time even after adjustment for insurance coverage, health care access, and food insecurity.

The study also found the prevalence of hypertension increased in lower-income adults during the study period, from 37.2% to 44.7%, while higher-income adults did not have a change in hypertension rates. Treatment and control of hypertension were unchanged in both groups with rates above 80%. The prevalence of smoking was consistently higher among lower-income adults and decreased among the higher-income adults during the study period. Results were published by Annals of Internal Medicine on Nov. 21.

“Our findings are especially concerning in the context of recent data showing worsening cardiovascular health among young U.S. adults,” said the study authors. “Targeted public health and policy initiatives to improve the prevention, diagnosis, and treatment of cardiovascular risk factors, particularly among low-income communities, are urgently needed to address the ongoing increase in cardiovascular mortality among middle-aged adults.”