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Cited by 97Public Health and Social InequalitiesHealth disparities and outcomesDiabetes Management and Education

The role of structural racism and geographical inequity in diabetes outcomes

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Agarwal, Shivani, Wade, Alisha N, Mbanya, Jean Claude, Yajnik, Chittaranjan, Thomas, Nihal, Egede, Leonard E, Campbell, Jennifer A, Walker, Rebekah J +2 more·2023·The Lancet
DOI 10.1016/s0140-6736(23)00909-1PMC PMC11329296
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Abstract

Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.

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Authors
Agarwal, S., Wade, A. N., Mbanya, J. C., Yajnik, C., Thomas, N., Egede, L. E., Campbell, J. A., Walker, R. J., Maple-Brown, L., & Graham, S.
Affiliations
  • Albert Einstein College of Medicine (US)
  • University of the Witwatersrand (ZA)
  • Université de Yaoundé I (CM)
  • King Edward Memorial Hospital Research Centre (IN)
  • Christian Medical College, Vellore (IN)
  • Medical College of Wisconsin (US)
  • Charles Darwin University (AU)
Corresponding author
Agarwal, Shivani
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2023-07
Volume
402
Issue
10397
Pages
235-249
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(23)00909-1
PMC
PMC11329296
OpenAlex
W4381743614
Cited by
97
References
167
Citations by year
2026: 20 · 2025: 41 · 2024: 25 · 2023: 11
FWCI
4.86
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • John E Fogarty International Center
  • NIDDK
  • NIMHD
  • American Diabetes Association
Topics
  • Social Sciences › Health › Public Health and Social Inequalities
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
structural racism, diabetes mellitus, social determinants of health, health disparities, diabetes outcomes, diabetes prevalence, health care access, health policy, sociocultural norms, economic development, regional disparities
MeSH terms
Social Factors, Systemic Racism, Diabetes Mellitus, Humans, Prevalence, Racism

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