The Influence of Social Vulnerability and Race on Diabetes Control

Abstract

Context: Social determinants of health (SDoH) and race are both well-established factors that influence diabetes outcomes. However, less is understood about how social vulnerability (SV) and race intersect to impact diabetes control.

Objective: To examine the additive impact of SV and race on diabetes control.

Design: Cross sectional study.

Setting: 48 practices across 7 counties in Western New York.

Patients: 22,912 patients.

Intervention: We defined diabetes control based on HEDIS standards. We assigned Social Vulnerability Index (SVI) scores to each patient based on census tract data and separately examined patient-reported SDoH measures. Multivariate logistic regression models were used to assess the additive effects of race and SV on diabetes control while controlling for age, sex, ethnicity, marital status and metropolitan status.

Results: 73.6% of patients had an HbA1c <8% (White 75.7%; Black 66.1%). Within each racial category, control worsened with increasing SVI. White patients in the highest vulnerability quartile had comparable control as Black patients in the lowest vulnerability quartile. After adjusting for SV, Black patients had significantly greater odds of uncontrolled diabetes compared to White patients (AOR 1.29, (CI 1.18, 1.41)). Patients reporting food insecurity (67.7% vs. 79.8%), housing insecurity (66.0% vs. 80.1%), and unmet transportation needs (67.7% vs. 79.2%) had lower rates of control compared to those without unmet needs.

Conclusions: Increasing SV was associated with worsening control across all racial groups. SVI did not fully mitigate the influence of race on diabetes control, highlighting the clinical importance and additive impact of both race and SV.

Keywords: diabetes; diabetes control; disparities; race; social determinants of health; social vulnerability index.