Diabetes Disparities: Why Prevention Isn't Equal for Everyone
"Elderly Native Hawaiians, Filipinos, and Japanese face higher risks of preventable diabetes hospitalizations compared to whites. Discover the hidden factors and what can be done."
Diabetes is a major health concern, especially for older adults. Approximately 25% of individuals aged 65 and older in the United States have diabetes mellitus. While this is a significant number on its own, the rates are even higher for certain racial and ethnic groups, particularly Asian Americans and Pacific Islanders (AA/PI).
Recent research has highlighted that Native Hawaiians, Filipinos, and Japanese elderly individuals face disproportionately high rates of diabetes and related complications. This leads to an important question: are these communities receiving the preventative care they need, and are there specific factors contributing to these disparities?
A groundbreaking study, conducted in Hawai'i between 2006 and 2010, delved into the racial and ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH). The study focused on elderly individuals (aged 65 and older) from Japanese, Chinese, Filipino, Native Hawaiian, and White backgrounds to uncover the root causes of these unequal outcomes and identify potential intervention points.
Hospitalization and Readmission Gaps
A completed five-year mixed-methods study documented disparities in hospitalizations for ambulatory care sensitive conditions in Hawai'i using statewide hospital discharge data. Patient interviews were used to identify factors contributing to those hospitalizations. Separately, a Hawai'i database covering inpatient data from 2008 to 2017 identified respiratory, digestive, mental, and nervous system diseases and disorders as the four major diagnostic categories with the most pediatric readmissions.
Unpacking the Disparities: Who's at Risk and Why?
The Hawai'i-based study revealed some striking differences in DRPH rates among various ethnic groups. The initial data showed that all AA/PI groups had higher unadjusted rates of DRPH compared to Whites, with Native Hawaiians and Filipinos experiencing the highest rates. This raised concerns about access to care, cultural factors, and the effectiveness of current prevention programs.
- Native Hawaiian Men: Even after accounting for other factors, Native Hawaiian men had a significantly higher risk of DRPH compared to White men. The adjusted rate ratio (aRR) was 1.59, meaning they were 59% more likely to be hospitalized for preventable diabetes-related issues.
- Filipino Men and Women: The disparity was even more pronounced for Filipinos. Filipino men had an aRR of 2.26, indicating a 126% higher risk of DRPH compared to White men. Similarly, Filipino women had an aRR of 1.61, a 61% increased risk compared to White women.
- Japanese Men: Japanese men also faced a significantly elevated risk, with an aRR of 1.86, an 86% increased risk of DRPH compared to White men.
Research on Access and Support
Research on older adults with type 2 diabetes examined disparities in compliance with keeping medical appointments in a managed care setting. A Waimānalo study gathered perspectives from 29 people living in Native Hawaiian and Pacific Islander communities about conducting longitudinal cohort studies on health-disparity mechanisms. Other Hawai‘i research assessed health literacy and social-network membership among 22 adults hospitalized with heart disease- or diabetes-related potentially preventable hospitalizations.
Limits of Broad Categories
Evidence on diabetes-related potentially preventable hospitalizations warns that combining Native Hawaiian, Chinese, Filipino, and Japanese populations into one Asian American or Pacific Islander category can conceal differences among heterogeneous groups. A systematic review found 42 studies evaluating health-care interventions intended to improve outcomes or reduce diabetes disparities among racial and ethnic minorities. More recent analysis reports that pharmacological and behavioral interventions that reduce diabetes risk have not been implemented equitably, contributing to disparities by race and ethnicity, age, socioeconomic status, and especially health-insurance status.
Differences Within Communities
In Hawaii's 2001 BRFSS data, Native Hawaiians and Part Native Hawaiians had the highest reported moderate and vigorous physical-activity levels among the Asian or Pacific Islander groups shown: 38.9% moderate and 23.9% vigorous. Japanese adults were reported at 32.1% moderate and 20.4% vigorous, while Filipino adults were at 31.8% and 18.6%, respectively. Broader research emphasizes that diabetes disparities vary by socioeconomic status, race, ethnicity, and state location, showing why comparisons within underserved communities matter.
Moving Towards Equity: What Can Be Done?
The study's conclusion is clear: Native Hawaiian, Filipino, and Japanese men, along with Filipino women, are at a higher risk for DRPH compared to their White counterparts. This highlights the urgent need for targeted interventions to address these disparities. Health care providers and public health programs must consider implementing culturally sensitive and effective programs to reduce potentially preventable hospitalizations within these communities.
Treatment and Prevention Outcomes
Trial and observational data document associations between diabetes treatment and HbA1c levels, supporting the hypothesis that differences in treatment regimens may contribute to different clinical outcomes across racial and ethnic subgroups. Evidence from real-world Diabetes Prevention Program translational studies also shows that adoption of prevention strategies and successful weight loss have varied by race and ethnicity. These findings suggest that an intervention's availability does not guarantee comparable results across patient groups.
Data, Cost, and Program Capacity
The CDC provides current diabetes data and statistics through reports and other research resources. A 2024 analysis described the economic burden of diabetes in the United States as $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect expenses. A 2026 report warned that a decline of more than half in the CDC diabetes research and prevention budget could reduce access to chronic-disease prevention programs and increase long-term health-care costs.
Social Conditions and Equitable Care
A scientific review concludes that differences in diabetes risk and outcomes can result from biological, clinical, and nonclinical factors. It also describes a substantial body of research documenting the adverse impact of health disparities in diabetes. Diabetes care guidance emphasizes that equitable access to care and support services is essential for preventing and managing chronic disease, while noting that the COVID-19 pandemic highlighted persistent health disparities and elevated risks for some racial and ethnic groups.