Structural Racism as an Upstream Social Determinant of Diabetes Outcomes: A Scoping Review. Diabetes Care 2023 Apr 01;46(4):667-677
Date
03/24/2023Pubmed ID
36952609Pubmed Central ID
PMC10090912DOI
10.2337/dci22-0044Scopus ID
2-s2.0-85150902866 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
OBJECTIVE: To evaluate the evidence on the role of structural racism as an upstream factor impacting diabetes outcomes, identify current gaps, and recommend areas for future work.
RESEARCH DESIGN AND METHODS: A reproducible search of Medline and Ovid was used. Structural factors based on the World Health Organization social determinants of health framework (governance, macroeconomic policy, social policy, public policy, and cultural and societal values) had to be included as measured variables or contextual factors discussed as upstream influences. Outcomes included 1) hemoglobin A1c (HbA1c), 2) LDL, 3) BMI, 4) quality of life, 5) self-efficacy, 6) mortality, 7) years of life lost, and 8) self-care behaviors.
RESULTS: Thirteen articles were included for final synthesis. Ten studies focused on governance, two on social policies, one on public policies, and one on cultural and societal values. Results highlight significant associations between structural racism and poorer clinical outcomes (HbA1c and blood pressure), worse self-care behaviors (diet and physical activity), lower standards of care, higher mortality, and more years of life lost for adults with diabetes.
CONCLUSIONS: There is a paucity of work investigating the relationship between structural racism and diabetes outcomes. Five areas for future work include 1) more rigorous research on the relationship between structural racism, downstream social determinants, and health outcomes in diabetes, 2) policy assessments specific to diabetes outcomes, 3) research designed to examine pathways and mechanisms of influence, 4) intervention development to mitigate the impact of structural racism, and 5) tracking and monitoring of change over time.
Author List
Egede LE, Campbell JA, Walker RJ, Linde SAuthors
Jennifer Annette Campbell PhD, MPH Assistant Professor in the Medicine department at Medical College of WisconsinLeonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultDiabetes Mellitus
Humans
Quality of Life
Social Determinants of Health
