Race, Structural Racism, and Prevalence of Diabetes in US Neighborhoods
Authors' conclusion
African American or Black race, historic structural racism, and contemporary structural racism were associated with higher diabetes prevalence at the census-tract level in the US. Domains of contemporary structural racism as measured by the SREI are potential targets for future interventions.
Study context
- Population
- US census tracts across 157 counties within 50 states and Washington, DC
- Participants
- 15,190 census tracts
- Exposure
- Associations of Black race, historic structural racism (redlining) and contemporary structural racism (structural racism effect index (SREI)) with diabetes prevalence
- Outcome
- Census-tract diabetes prevalence (CDC PLACES 2019)
Methodological detailsstructural equation modeling, standardized estimates (β), Conducted September 2025 to February 2026
- Structural equation modeling
- Standardized estimates (β)
- Conducted September 2025 to February 2026
Main finding
As reported in the abstract
Historic structural racism, direct: β
0.02
95% CI −0.05 to 0.08P = .001
Contemporary structural racism, direct: β
0.56
95% CI 0.51 to 0.61P < .001
Observational data: associations, not effects.
Further findings
Indirect association of historic structural racism via contemporary structural racism
- β
- 0.17 (95% CI, 0.15 to 0.20; P < .001)
Pathway from Black race to diabetes prevalence
- Via contemporary structural racism: β
- 0.58 (95% CI, 0.52 to 0.63; P < .001)
- Via historic structural racism: β
- 0.18 (95% CI, 0.14 to 0.22; P < .001)
Descriptive: diabetes prevalence and Black population share
- Mean (SD) diabetes prevalence: 11.8% (4.9%)
- Mean (SD) African American or Black population: 26.7% (31.4%)
Original publication
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