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Purpose <p>Our objective was to quantify the association of social determinants of diabetes mortality and effect modification by race/ethnicity and COVID-19 pandemic time period.</p> Methods <p>The Healthy Places Index (HPI) composites 23 indicators of neighborhood socio-economic and environmental conditions, and healthcare access. In this cross-sectional observational study of Californians aged ≥18 years, we aggregated 44,488 diabetes deaths and populations to 2010 census tracts from death certificates and U.S. census populations. Log-linear regression was used to test associations between age-adjusted diabetes mortality rates and HPI deciles in pre-pandemic (2015–2019) and pandemic (2020–2021) periods.</p> Results <p>Mortality rates in 2015–2019 were inversely related to HPI scores and declined 12.7% per HPI decile. The rate ratio (RR<sub>D1/D10</sub>) of diabetes mortality rates between HPI deciles 1 and 10 (most favorable scores) was 3.95 (CI<sub>95%</sub>: 3.43–4.55). In the pandemic period, the mortality gradient was steeper [-14.7% per decile; RR<sub>D1/D10,</sub> 4.51 (CI<sub>95%</sub>: 3.96–5.13)] and disproportionately increased at lower HPI deciles. The HPI-attributable fraction of diabetes mortality was 0.54 prior to and 0.57 during the pandemic. Pre-pandemic, Black individuals had the highest age-adjusted mortality rates, but non-Hispanic White individuals experienced the steepest HPI-mortality gradient (-14.9% per decile). Differences in mortality rates between HPI deciles 1 and 10 within race/ethnicity groups exceeded differences between race/ethnicity groups.</p> Conclusion <p>The pandemic exacerbated pre-existing diabetes disparities. Health equity metrics incorporating area-based socioeconomic measures can be integrated into routine public health surveillance, which can inform policies that reduce diabetes health inequities.</p>

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Race and Neighborhood Social Determinants of Diabetes Mortality in California Adults, before and during the COVID-19 Pandemic

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Neil Maizlish,
  • Adrienne Damicis,
  • Tracy Delaney,
  • Helen Dowling

摘要

Purpose

Our objective was to quantify the association of social determinants of diabetes mortality and effect modification by race/ethnicity and COVID-19 pandemic time period.

Methods

The Healthy Places Index (HPI) composites 23 indicators of neighborhood socio-economic and environmental conditions, and healthcare access. In this cross-sectional observational study of Californians aged ≥18 years, we aggregated 44,488 diabetes deaths and populations to 2010 census tracts from death certificates and U.S. census populations. Log-linear regression was used to test associations between age-adjusted diabetes mortality rates and HPI deciles in pre-pandemic (2015–2019) and pandemic (2020–2021) periods.

Results

Mortality rates in 2015–2019 were inversely related to HPI scores and declined 12.7% per HPI decile. The rate ratio (RRD1/D10) of diabetes mortality rates between HPI deciles 1 and 10 (most favorable scores) was 3.95 (CI95%: 3.43–4.55). In the pandemic period, the mortality gradient was steeper [-14.7% per decile; RRD1/D10, 4.51 (CI95%: 3.96–5.13)] and disproportionately increased at lower HPI deciles. The HPI-attributable fraction of diabetes mortality was 0.54 prior to and 0.57 during the pandemic. Pre-pandemic, Black individuals had the highest age-adjusted mortality rates, but non-Hispanic White individuals experienced the steepest HPI-mortality gradient (-14.9% per decile). Differences in mortality rates between HPI deciles 1 and 10 within race/ethnicity groups exceeded differences between race/ethnicity groups.

Conclusion

The pandemic exacerbated pre-existing diabetes disparities. Health equity metrics incorporating area-based socioeconomic measures can be integrated into routine public health surveillance, which can inform policies that reduce diabetes health inequities.