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Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S.

  • Zhu, Yeyi1, 2
  • Sidell, Margo A3
  • Arterburn, David4
  • Daley, Matthew F5
  • Desai, Jay6
  • Fitzpatrick, Stephanie L7
  • Horberg, Michael A8
  • Koebnick, Corinna3
  • McCormick, Emily9
  • Oshiro, Caryn10
  • Young, Deborah R3
  • Ferrara, Assiamira11
  • 1 Division of Research, Kaiser Permanente Northern California, Oakland, CA [email protected]
  • 2 University of California, San Francisco, San Francisco, CA.
  • 3 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
  • 4 Kaiser Permanente Washington Health Research Institute, Seattle, WA.
  • 5 Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
  • 6 HealthPartners Institute, Bloomington, MN.
  • 7 Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
  • 8 Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD.
  • 9 Denver Public Health Department, Denver, CO.
  • 10 Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI.
  • 11 Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Published Article
Diabetes care
Publication Date
Dec 01, 2019
DOI: 10.2337/dc19-0532
PMID: 31537541


To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category. In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012-2013 were included. Diabetes and prediabetes were ascertained by diagnosis and laboratory results; antihyperglycemic medications were also included for diabetes ascertainment. The age-standardized diabetes and prediabetes prevalence estimates were 15.9% and 33.4%, respectively. Diabetes but not prediabetes prevalence increased across BMI categories among all racial/ethnic groups (P for trend < 0.001). Racial/ethnic minorities reached a given diabetes prevalence at lower BMIs than whites; Hawaiians/Pacific Islanders and Asians had a diabetes prevalence of 24.6% (95% CI 24.1-25.2%) in overweight and 26.5% (26.3-26.8%) in obese class 1, whereas whites had a prevalence of 23.7% (23.5-23.8%) in obese class 2. The age-standardized prediabetes prevalence estimates in overweight among Hispanics (35.6% [35.4-35.7%]), Asians (38.1% [38.0-38.3%]), and Hawaiians/Pacific Islanders (37.5% [36.9-38.2%]) were similar to those in obese class 4 among whites (35.3% [34.5-36.0%]), blacks (36.8% [35.5-38.2%]), and American Indians/Alaskan Natives (34.2% [29.6-38.8%]). In adjusted models, the strength of association between BMI and diabetes was highest among whites (relative risk comparing obese class 4 with normal weight 7.64 [95% CI 7.50-7.79]) and lowest among blacks (3.16 [3.05-3.27]). The association between BMI and prediabetes was less pronounced. Racial/ethnic minorities had a higher burden of diabetes and prediabetes at lower BMIs than whites, suggesting the role of factors other than obesity in racial/ethnic disparities in diabetes and prediabetes risk and highlighting the need for tailored screening and prevention strategies. © 2019 by the American Diabetes Association.

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