National Health Interview Survey (NHIS)

The NHIS is a household-based interview survey that collects responses in all 50 states and the District of Columbia. For this analysis, multiple years of data were combined to obtain more statistically reliable estimates for the various diabetes categories (see the next paragraph for further details). Between 2006 and 2010, NHIS provided data for approximately 74,000–90,000 interviewed persons annually (3). The final annual NHIS response rates among adults during 2005–2010 were ≥60.8% for adults and ≥70.7% for youth. Since the NHIS is an interview survey, it is only able to distinguish people with diagnosed diabetes from people without diagnosed diabetes. To identify people with diabetes, NHIS asked respondents (or rarely a family proxy), “(Other than during pregnancy for females), Have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?” If the response was “Yes,” the person was classified to have diagnosed diabetes. Persons responding “No” or “Borderline” were classified not to have diagnosed diabetes. People who reported a diabetes diagnosis were then asked “How old were you when a doctor or other health professional first told you that you had diabetes or sugar diabetes?” This was used to identify the age at diagnosis. Since diabetes was only based on interview information, some persons were classified not to have diabetes but, in fact, did have undiagnosed diabetes. Other research has found that approximately 28% of persons with diabetes have undiagnosed diabetes (8).

The main focus of this chapter is on adults with diabetes diagnosed at age ≥20 years. To produce stable estimates for people with diagnosed diabetes, multiple years of data were combined. For adults with diabetes diagnosed at age ≥20 years, 2009 and 2010 data were combined. For people with diabetes diagnosed at age <20 years, more years of data were combined (generally 2006–2010) to increase the analytic sample size. Where possible, results were presented for youth (age <20 years) with diabetes. In 2009–2010, only 35 adults age ≥20 years (0.05%) and, in 2006–2010, only 30 youth age <20 years (0.05%) had missing data and could not be classified for diagnosed diabetes. Additional information on the NHIS is available (3,9,10,11,12). The final person sample weight was used for the NHIS estimates.

National Health and Nutrition Examination Survey (NHANES)

The NHANES is an interview and examination survey of approximately 5,000 people in 15 locations per year in the United States. In-home interviews are followed by physical examinations and laboratory tests in Mobile Examination Centers. Persons are selected in households based on a complex survey design. The response rates were ≥70% for all years of NHANES data used in this analysis (13). Data were released in 2-year cycles. For the new analyses in this chapter, data collected from 2005 to 2010 were combined.

With the combined interview and examination components of the NHANES, it was possible to classify people as having diagnosed diabetes, undiagnosed diabetes, prediabetes, and no diabetes.

The interview data were used to identify people with diagnosed diabetes. If a person answered “Yes” to the question “(Other than during pregnancy, if female)…Have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?,” then they were considered to have diagnosed diabetes. All others were classified not to have diagnosed diabetes. To identify undiagnosed diabetes, two definitions were used. Participants who did not have diagnosed diabetes and (1) had glycosylated hemoglobin (A1c) ≥6.5% (≥48 mmol/mol) or (2) were randomly assigned to the morning sample, fasted 8–<24 hours, and had fasting plasma glucose (FPG) ≥126 mg/dL (≥6.99 mmol/L) were classified to have undiagnosed diabetes; this is considered the clinical definition because these measures are more likely to be used in the medical community due to ease of use for physicians and patients and potentially lower cost. In addition, those who satisfied the clinical definition for diabetes or who had 2-hour plasma glucose ≥200 mg/dL (≥11.10 mmol/L) after a 75 gram oral glucose challenge (i.e., an oral glucose tolerance test [OGTT]) were classified to have undiagnosed diabetes; this is referred to as the research definition because the added 2-hour OGTT is less likely to be used in the medical community. People were considered to have prediabetes among those without diagnosed or clinically defined undiagnosed diabetes if their FPG was 100–125 mg/dL (5.55–6.94 mmol/L) or their A1c was 5.7%–6.4% (39–46 mmol/mol). Those with A1c <5.7% and FPG <100 mg/dL were classified as having no diabetes. In 2005–2010, 6.1% could not be classified using the clinical definition, and 13.7% could not be classified using the research definition. NHANES-recommended glucose corrections were used (14). Sample weighted estimates included home interview weights for diagnosed diabetes; Mobile Examination Center examination weights for undiagnosed diabetes or prediabetes identified by A1c; and fasting or OGTT weights for no diabetes, undiagnosed diabetes, or prediabetes identified by FPG or OGTT, respectively, which maximizes the use of survey information and sample sizes.

Age Distribution

The age distribution of people with diagnosed diabetes (mean age 59.3 years) was older than people without diagnosed diabetes (mean age 35.3 years) (Figure 8.1). The range of ages for people with diabetes was 2–85 years, and the mode of the age distribution was 85 years (which was the top age released for all persons age ≥85 years for confidentiality reasons). The highest percentage of people with diabetes was in the 50–69 years age group (approximately 50%). In contrast, the highest percentage of people without diabetes was in the <30 years age group (approximately 45%). Among adults age ≥20 years in 2009–2010, the mean ages were 46.3 years for those with diabetes diagnosed age <20 years and 60.5 years for those diagnosed age ≥20 years, which were older than the mean age of 45.9 years for adults without diabetes.

Sex Distribution

In 2009–2010, among all ages, a significantly higher percentage of people with diabetes were male (51.2%) compared to people without diabetes (48.8%) (Appendix 8.1). In 2009–2010, among adults with diabetes diagnosed age ≥20 years, percentages were not significantly different for males (51.4%) compared with females (48.6%) (Figure 8.2, Appendix 8.2). In 2006–2010, no significant sex difference existed among adults with diabetes diagnosed age <20 years (48.9% male and 51.1% female) (Figure 8.2, Appendix 8.2), nor among youth with diabetes diagnosed age <20 years (52.6% male and 47.4% female) (Figure 8.2, Appendix 8.3).

FIGURE 8.1

Age Distribution of Persons, by Diagnosed Diabetes Status, U.S., 2009–2010. Data are self-reported.

FIGURE 8.2

Sex Distribution by Diabetes Status, Age at Diabetes Diagnosis, and Race/Ethnicity, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * Current age: adults ≥20 years, youth <20 years

Race/Ethnicity Distribution

People with diabetes in the United States had diverse race and ethnicity backgrounds (Figure 8.3). In 2009–2010, among all persons with diagnosed diabetes, non-Hispanic white persons comprised the largest subgroup (64.9%) followed by non-Hispanic black (15.7%), Hispanic (14.6%), non-Hispanic Asian/Pacific Islander (3.9%), and non-Hispanic American Indian and Alaska Native (0.9%). The race and ethnicity distribution of people without diabetes was 65.9%, 12.6%, 16.2%, 4.7%, and 0.6%, respectively (Appendix 8.1). Among all ages in 2009–2010, the only race/ethnicity group that had a significantly higher percentage in those with diabetes compared to those without diabetes was non-Hispanic black persons (15.7% and 12.6%, respectively). The largest population subgroup among Hispanics was Mexican American, which comprised a similar percentage among persons with or without diabetes (Appendix 8.1). About 1% of people with diabetes were in each of the non-Hispanic Asian/Pacific Islander subgroups surveyed, which was similar to the estimates for most of the Asian/Pacific Islander subgroups without diabetes. When non-Hispanic and Hispanic American Indian and Alaska Native categories were combined, the total included 1.2% of all adults with diabetes in the United States (data not shown).

In 2009–2010, among adults with diabetes diagnosed age ≥20 years, 64.4% were non-Hispanic white, 15.8% non-Hispanic black, 14.8% Hispanic, 4.1% non-Hispanic Asian/Pacific Islander, and 0.9% American Indian and Alaska Native (Figure 8.4, Appendix 8.2). The race/ethnicity distribution among adults without diabetes in 2009–2010 was 69.6% non-Hispanic white, 11.4% non-Hispanic black, 13.6% Hispanic, 4.8% non-Hispanic Asian/Pacific Islander, and 0.6% American Indian and Alaska Native. In 2006–2010, the percentages among adults with diabetes diagnosed age <20 years were 65.7% non-Hispanic white, 16.4% non-Hispanic black, 13.9% Hispanic, 2.8% non-Hispanic Asian/Pacific Islander, and 1.2% American Indian and Alaska Native.

FIGURE 8.3

Distribution of Race/Ethnicity Among Persons With Diagnosed Diabetes, U.S., 2009–2010. Data are self-reported. * Hispanic includes Hispanic American Indian/Alaska Native; Other Hispanic includes: multiple Hispanic, Dominican Republic, Other Latin (more...)

FIGURE 8.4

Distribution of Race/Ethnicity, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * Current age: adults ≥20 years, youth <20 years

Except for non-Hispanic Asian/Pacific Islanders and non-Hispanic American Indian and Alaska Native persons in whom the estimate was unreliable, the percentages were 58.1%, 23.9%, and 16.9%, respectively, for youth age <20 years with diabetes (Figure 8.4, Appendix 8.3).

Age Distribution by Sex

Among adults, 87.2% of men and women with diabetes diagnosed age ≥20 years were age ≥45 years compared to 50.3% of adults without diabetes (Appendix 8.4). Fewer men and women diagnosed age ≥20 years were age 20–44 years (13.5% and 12.1%, respectively) compared to men and women without diabetes (51.4% and 48.1%, respectively) (Appendix 8.4). In 2006–2010, among adults with diabetes diagnosed age <20 years, 43.0% of men and 42.8% of women with diabetes were age 20–44 years; 36.7% of men and 31.2% of women were age 45–64 years; and 20.3% of men and 26.0% of women were age ≥65 years (data not shown).

Age Distribution by Race/Ethnicity

Adults with diabetes were older than adults without diabetes in every race/ethnicity group examined (Figure 8.5, Appendix 8.4). Considering groups having statistically reliable estimates, 79.7%–90.2% of non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic Asian/Pacific Islander adults with diabetes diagnosed age ≥20 years were age ≥45 years in 2009–2010 compared to 32.3%–55.7% of adults without diabetes. A larger percentage of non-Hispanic white adults with or without diabetes were age ≥65 years and a smaller percentage were age 20–44 years compared to non-Hispanic black or Hispanic adults. The percentage of adults age ≥65 years with diabetes was 42.9% of non-Hispanic white, 31.6% of non-Hispanic black, 29.6% of Hispanic, and 39.3% of non-Hispanic Asian/Pacific Islander adults (Appendix 8.4).

FIGURE 8.5

Distribution of Age Among Adults Age ≥20 Years, by Diabetes Status and Race/Ethnicity, U.S., 2009–2010. Data are self-reported. Error bars represent 95% confidence intervals.

Age at Diagnosis of Diabetes

In 2009–2010, the mean and median ages at diagnosis were 48.3 and 49.3 years for all adults with diabetes (Appendix 8.5). For adults with diabetes diagnosed age ≥20 years, the mean age at diagnosis for adults age ≥20 years was 50.6 years; it was similar for men and women, and it varied by race/ethnicity group (Figure 8.6). Non-Hispanic white adults had a significantly older mean age at diagnosis (52.3 years) compared to non-Hispanic black (47.4 years), all Hispanic (47.3 years), Mexican American (46.2 years), non-Hispanic Asian/Pacific Islander adults (49.4 years), and non-Hispanic American Indian and Alaska Native adults (46.1 years) (Appendix 8.5). In 2006–2010, the mean age at diagnosis was 9.6 years among adults diagnosed age <20 years, and no significant difference existed by sex. The only significant difference by race/ethnicity in this younger onset group was between the Hispanic and non-Hispanic American Indian and Alaska Native groups. Their mean ages at diagnosis were 7.5 years and 14.0 years, respectively (Figure 8.6, Appendix 8.5). Median ages are presented in Appendix 8.5.

Duration of Diabetes

In 2009–2010, among all adults (age ≥20 years) with diabetes, the mean duration of diabetes was 11.6 years and the median duration was 7.6 years (Appendix 8.6). The range for diabetes duration among adults with diabetes was 1–84 years, and the mode for the diabetes duration was 2 years (noting that the top age was assigned as 85 years for those age ≥85 years). Men had a lower mean and median duration than women, but no significant race or ethnicity difference existed.

Among adults with diabetes diagnosed age ≥20 years, the overall mean duration was 9.9 years and was higher in women (10.7 years) compared to men (9.1 years) (Appendix 8.6). The respective median durations were 6.8, 7.5, and 6.3 years. Adults with diabetes diagnosed age ≥20 years had a shorter duration of diabetes than adults diagnosed age <20 years. In 2006–2010, the mean duration of diabetes was 39.7 years and the median was 38.6 years in adults diagnosed age <20 years, and there was no significant sex difference for mean duration (40.1 years for women vs. 39.2 years for men). In 2009–2010, among adults with diabetes diagnosed age ≥20 years, 58.6% had a duration of diabetes <10 years, and the percentages decreased as the length of diabetes duration increased (Figure 8.7). In contrast, during 2006–2010 among adults with diabetes diagnosed age <20 years, the percentage was highest for those with diabetes duration ≥25 years; 77.2% had a duration ≥20 years and more than one-third reported a diabetes duration ≥50 years (Figure 8.7, Appendix 8.7).

FIGURE 8.6

Mean Age at Diabetes Diagnosis Among Adults Age ≥20 Years, by Age at Diabetes Diagnosis, Sex, and Race/Ethnicity, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * 2009–2010

FIGURE 8.7

Duration of Diabetes Among Adults Age ≥20 Years, by Age at Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * 2009–2010

The only significant difference between race/ethnicity groups for mean diabetes duration was between Hispanic and non-Hispanic American Indian and Alaska Native groups (45.1 years and 24.7 years, respectively) whose diabetes was diagnosed age <20 years (Appendix 8.6). Among those with diabetes diagnosed age ≥20 years, the estimated mean duration range was from 9.1 years for other Hispanic adults to 10.4 years for non-Hispanic black adults, and among those with diabetes diagnosed age <20 years the estimated mean duration range was from 24.7 years for non-Hispanic American Indian and Alaska Native adults to 45.2 years for Mexican American adults.

State of Residence in the United States

In general, the rank order of top 10 states with the largest percentages of the total diabetes population in the United States is similar to the rank order of states with the largest percentages of the total U.S. population without diabetes (Appendix 8.8). Approximately 53% of people with diabetes compared to 52% of people without diabetes lived in these 10 states. The top 10 states with diabetes in descending order were California, Texas, Florida, New York, Ohio, Illinois, Pennsylvania, Michigan, North Carolina, and Georgia. The rank order of states with the largest percentages of U.S. persons without diabetes in descending order was nearly identical, except for rank placement of Ohio, which ranked fifth for the percentage of the U.S. people with diabetes (4.5%) but ranked seventh for the percentage of U.S. people without diabetes (4.0%). With the exception of California and Texas, all other top 10 states are east of the Mississippi River.

Metropolitan/Nonmetropolitan County of Residence

The majority of adults with and without diabetes lived in more urban counties. In 2009–2010, 80.4% of adults with diabetes diagnosed age ≥20 years lived in metropolitan counties (that is, large, medium, or small) compared to 84.3% of adults without diabetes (Figure 8.8, Appendix 8.9). The percentage living in nonmetropolitan counties, which include micropolitan counties in micropolitan statistical areas and nonmetropolitan counties not in micropolitan statistical areas (i.e., non-core counties), was 19.7% among those diagnosed age ≥20 years compared with 15.8% of adults without diabetes. No significant percentage differences were observed between adults with diabetes diagnosed age ≥20 years and those without diabetes in the detailed metropolitan/nonmetropolitan categories. During 2006–2010, adults with diabetes diagnosed age <20 years had a similar metropolitan/nonmetropolitan pattern as adults diagnosed age ≥20 years (Figure 8.8, Appendix 8.9).

FIGURE 8.8

Metropolitan/Nonmetropolitan County of Residence of Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * Reference 15

Region of the United States

Overall, the regional distribution of all adults with diabetes diagnosed age ≥20 years was generally similar to the distribution of adults without diagnosed diabetes (16.0% in the Northeast, 24.8% in the Midwest, and 20.5% in the West compared to 17.9%, 23.5%, and 23.3%, respectively, for adults without diabetes) (Figure 8.9, Appendix 8.10). A higher percentage of adults with diabetes diagnosed age <20 years lived in the South (46.1%) and a lower percentage in the West (16.4%) compared to adults without diabetes (35.3% and 23.3%, respectively) (Appendix 8.10).

The regions of the United States where most diabetic individuals lived varied by race and ethnicity, and the distributions were similar to those among adults without diabetes; however, one significant difference existed (Appendix 8.10). Other Hispanic adults (i.e., Hispanic, but not Mexican American) with diabetes diagnosed age ≥20 years less often lived in the West (19.1%) compared to other Hispanic adults without diabetes (31.1%). The regions with the largest race/ethnicity percentages of total U.S. adults with diabetes diagnosed age ≥20 years were: 66.3% of non-Hispanic white adults resided in the Midwest and South; 79.1% of non-Hispanic black adults resided in the Midwest and South; 77.4% of Hispanic adults resided in the South and West; 90.2% of Mexican American adults (the largest Hispanic subgroup) also resided in the South and West; 51.9% of non-Hispanic Asian/Pacific Islander adults resided in the West; and 53.4% of non-Hispanic American Indian and Alaska Native adults resided in the West.

In 2006–2010, higher percentages of non-Hispanic white and non-Hispanic black adults with diabetes diagnosed age <20 years resided in the South (40.9% and 71.4%, respectively) compared to non-Hispanic white and non-Hispanic black adults without diabetes in the South in 2009–2010 (33.1% and 56.1%, respectively) (Appendix 8.10).

Regions of the World

In general, people with or without diabetes in the United States were born in similar regions of the world. In 2009–2010, 83.2% of U.S. adults with diabetes diagnosed age ≥20 years and 83.0% of adults without diabetes were born in the United States (Appendix 8.11). However, there were a few small, but significant, exceptions. Lower percentages of U.S. adults with diabetes were born in Asia and South America. No sex difference existed. Among adults with diabetes, the percentages of U.S.-born were 95.5% of non-Hispanic white, 90.0% of non-Hispanic black, 39.2% of Hispanic (47.9% of Mexican American and 24.2% of other Hispanic), 19.9% of non-Hispanic Asian/Pacific Islander, and 93.7% of non-Hispanic American Indian and Alaska Native adults. Among non-Hispanic Asian/Pacific Islander adults with diabetes diagnosed age ≥20 years, 33% were born in Southeast Asia, 25.8% in the Indian subcontinent, and 17.7% in other Asian/Pacific Islander areas. Among Hispanic adults with diabetes diagnosed age ≥20 years, the percentage born in the United States was similar among those without diabetes, except for the other Hispanic group. In 2006–2010, among those diagnosed with diabetes age <20 years, 96.8% of youth currently age <20 years and 85.9% of adults currently age ≥20 years with diabetes were born in the United States, which are significantly different.

Years Living in the United States, Among Immigrants

In 2009–2010, immigrant adults with diabetes lived in the United States longer than immigrant adults without diabetes. A higher percentage of immigrant adults with diabetes (72.3% diagnosed age <20 years and 84.2% diagnosed age ≥20 years) lived in the United States for more than 15 years than immigrant adults without diabetes (58.5%) (Figure 8.10). The percentage having lived in the United States ≥15 years increased within the age groups 20–44, 45–64, and ≥65 years. The percentages were 66.7%, 86.1%, and 89.7% among adults with diabetes diagnosed age ≥20 years compared to 42.3%, 79.7%, and 89.2% among adults without diabetes (data not shown). Among adults with diabetes, there were no significant sex or race/ethnicity differences for the years living in the United States (data not shown).

FIGURE 8.9

Region of Residence Among Adults Age ≥20 Years, by Diabetes Status, U.S., 2009–2010. Data not available for U.S. Territories. Data are self-reported. Error bars represent 95% confidence intervals.

FIGURE 8.10

Years in the United States Among Adults Age ≥20 Years Who Were Immigrants, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * 2009–2010

Marital Status

A higher percentage of adults who had diabetes diagnosed age ≥20 years were ever married (currently married, divorced/separated, or widowed) and a lower percentage never married or currently lived with a partner compared to adults without diabetes (Figure 8.11). A larger percentage of adults with diabetes age 20–44 years were divorced or separated than adults without diabetes (12.8% vs. 7.6%) (Appendix 8.12). A larger percentage of men with diabetes diagnosed age ≥20 years were married than women with diabetes diagnosed age ≥20 years or men without diabetes (68.9%, 48.9%, 57.6%, respectively), and a larger percentage of women with diabetes diagnosed age ≥20 years were widowed (20.5%) or divorced/separated (18.1%) compared to men with diabetes diagnosed age ≥20 years (5.8% and 12.0%) or women without diabetes (8.4% and 12.8%). The marital status differences between adults with or without diabetes were diminished with increasing age groups. Regardless of diabetes status, men age ≥65 years were more often married (>70%) than women (<45%) (Appendix 8.12). The percentage married ranged from 71.5% among non-Hispanic Asian/Pacific Islander to 42.0% among non-Hispanic black adults with diabetes diagnosed age ≥20 years and from 66.1% to 35.8% among adults without diabetes (Appendix 8.13). In 2006–2010, adults with diabetes diagnosed age <20 years had similar marital status compared to adults in 2009–2010 with diabetes diagnosed age ≥20 years; however, the younger diagnosis group was also more likely to never have married (Appendix 8.12).

Type of Cohabitation

In 2009–2010, 78.9% of adults with diabetes diagnosed age ≥20 years lived with others (32.0% with a married spouse but no child, 22.0% with a child with or without another adult, and 24.9% with other adults but no child). Nearly 83% of adults without diabetes lived with someone and were less likely to have lived with a married spouse only (23.0%) and more likely to have lived with a child (37.1%) compared to adults with diabetes diagnosed age ≥20 years (Figure 8.12, Appendix 8.14). In 2009–2010, within race/ethnicity groups (except non-Hispanic Asian/Pacific Islanders), the percentage who lived alone was higher in adults with diabetes diagnosed age ≥20 years compared to adults without diabetes: 22.0% versus 18.2% in non-Hispanic white; 27.4% versus 21.6% in non-Hispanic black; and 13.5% versus 9.3% in Hispanic adults (Appendix 8.15).

FIGURE 8.11

Marital Status Among Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * 2009–2010

FIGURE 8.12

Type of Cohabitation Among Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * With children includes a mother or father living (more...)

Most of these differences between adults with or without diabetes by race/ethnicity did not remain significantly different within age-specific categories (Appendix 8.15). In 2006–2010, compared to those with diabetes diagnosed age ≥20 years, the percentage of adults with diabetes diagnosed age <20 years who were married with a spouse was lower (23.0% vs. 32.0%), and the percentage who lived with a child was higher (30.5% vs. 22.0%) (Figure 8.12, Appendix 8.14).

Family Size

Adults with diabetes diagnosed age ≥20 years lived in households with smaller family size than adults without diabetes. A higher percentage of adults with diabetes diagnosed age ≥20 years lived in a family of two persons compared to adults without diabetes (39.3% vs. 29.3%) and less often lived in a family of four or more (21.3% vs. 29.6%); this pattern was present for both sexes (Figure 8.13, Appendix 8.16). Women with diabetes were more often in a family size of one compared to men with diabetes (28.4% vs. 19.9%). Family size varied by race/ethnicity group among adults with and without diabetes. Among those with diabetes diagnosed age ≥20 years, non-Hispanic white adults more often had a family of two (44.8%); Hispanic and non-Hispanic Asian/Pacific Islander adults more likely had a family of four or more (41.0% and 36.9%), and non-Hispanic black adults were equally likely to have a family size of one or two (30.2% and 33.1%) (Appendix 8.17). Over 95% of all youth (age <20 years) with diabetes lived in families with two or more members (Figure 8.13, Appendix 8.16).

Education

Adults age ≥25 years with diabetes attained less education than similar age adults without diabetes (Figure 8.14). While the percentage with some college education was similar, a smaller percentage of adults with diabetes diagnosed age ≥20 years graduated from college (17.6%) compared to adults without diabetes (31.4%), and a larger percentage had less than a high school education (23.7% vs. 13.2%) (Figure 8.14, Appendices 8.18 and 8.19). By age, differences existed between adults with and without diabetes within age groups 25–44 and 45–64 years but were less pronounced in adults age ≥65 years. The percentage with <9th grade education was highest in the ≥65 years age group (16.3% with diabetes diagnosed age ≥20 years and 9.0% without diabetes). Among adults with diabetes diagnosed age ≥20 years, women were less likely to be college graduates compared to men (13.8% vs. 21.2%). A similar pattern, but much smaller difference, existed among women (30.4%) and men (32.5%) without diabetes. Non-Hispanic Asian/Pacific Islander adults in both groups had the highest level of education followed by non-Hispanic white, non-Hispanic black, and Hispanic adults. In 2006–2010, adults age ≥25 years with diabetes diagnosed age <20 years had similar levels of attained education as adults in 2009–2010 who had diabetes diagnosed age ≥20 years (Appendices 8.18 and 8.19).

FIGURE 8.13

Family Size Among Persons, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * Current age: adults ≥20 years, youth <20 years

Family Income

In 2009–2010, adults with diabetes had a lower family income than those without diabetes (Figure 8.15). Within age groups, adults with diabetes compared to adults of similar age without diabetes had less family income, except for the age group 20–44 years (Appendix 8.20). Adult men and women with diabetes had less family income compared to their counterparts without diabetes. A larger percentage of women with diabetes had a family income <$35,000 (51.2%) compared to men with diabetes (36.8%) or women (34.6%) or men (30.1%) without diabetes. Adults with diabetes had lower family income within non-Hispanic white and non-Hispanic black groups, but no significant difference existed between adults with or without diabetes who were Hispanic or non-Hispanic Asian/Pacific Islander. After considering both age and race/ethnicity groups, some adults age 45–64 years with diabetes (e.g., non-Hispanic white and non-Hispanic black adults with diabetes diagnosed age ≥20 years) had lower family incomes than similar age adults without diabetes (Appendix 8.21).

In 2007–2010, adults with diabetes diagnosed age <20 years had lower family income than adults in 2009–2010 with diabetes diagnosed age ≥20 years (Figure 8.15, Appendix 8.20). Among persons with diabetes diagnosed age <20 years, adults and youth (age <20 years) had similar family incomes (Figure 8.15).

Poverty Income Ratio

A higher percentage of adults with diabetes diagnosed age ≥20 years were below or near the poverty level compared to adults without diabetes. Thirty-eight percent (38.4%) had a PIR <2.00 compared to 30.7% of adults without diabetes, and fewer adults with diabetes (31.6%) were in the most economically advantaged PIR category (≥4.00) compared to adults without diabetes (40.8%) (Figure 8.16, Appendix 8.22). A higher percentage of women compared to men were below the poverty level (PIR <1.00): 19.0% of women and 10.9% of men with diabetes diagnosed age ≥20 years compared to 14.7% and 11.7% of women and men without diabetes. Among adults with or without diabetes, the age group 20–44 years had the highest percentage below poverty (PIR <1.00), and the age group 45–64 years had the highest percentage in the PIR ≥4.00 group. Non-Hispanic black and Hispanic adults had a higher percentage below the poverty level compared to non-Hispanic white or Asian/Pacific Islander adults (Appendices 8.22 and 8.23).

FIGURE 8.14

Education Among Adults Age ≥25 Years, by Diabetes Status, Age at Diabetes Diagnosis, and Race/Ethnicity, U.S., 2006–2010. Education status was assessed above current age 25 years to allow time to graduate from college. Data are self-reported. (more...)

In 2006–2010, 23.8% of adults with diabetes diagnosed age <20 years lived below poverty (PIR <1.00) compared to 14.8% of adults in 2009–2010 who had diabetes diagnosed age ≥20 years (Figure 8.16, Appendices 8.22 and 8.23). The PIR distribution for youth (data not shown) and adults with diabetes diagnosed age <20 years were not significantly different, and around 50% were below or near the poverty level (PIR <2.00) (Figure 8.16).

FIGURE 8.15

Family Income Among Persons, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2007–2010. Data are self-reported for 70%–90% of respondents in each category and imputed for others. Error bars represent 95% confidence intervals. * (more...)

FIGURE 8.16

Family Poverty Income Ratio Among Persons, by Diabetes Diagnosis and Sex, U.S., 2007–2010. Subgroup analysis by sex was not possible for youth <20 years because of insufficient sample size. Poverty Income Ratio (PIR) is based on family (more...)

Main Language of Interview

English was spoken by the vast majority of people with and without diabetes in the United States, and Spanish was the next most common spoken language. In 2009–2010, English only was used during 93.9% of NHIS interviews of people with diabetes diagnosed at age ≥20 years and during 94.4% of interviews with those without diabetes (data not shown). Spanish only or Spanish and English were used for about 5% of interviews of adults with or without diabetes. Language use was similar by age and sex, with the range for English only being 92.9% (for age 20–44 years) to 94.5% (for males). Regardless of diabetes status, 99% of non-Hispanic white and non-Hispanic black adults spoke English, and among Hispanic adults, about 22% spoke Spanish only and 14% spoke English and Spanish for their interview. These percentages were similar in Hispanic subgroups. Among all non-Hispanic Asian/Pacific Islander adults, regardless of diabetes status, approximately 93% used English only for their interview. In 2006–2010, among persons with diabetes diagnosed at age <20 years, 93.4% of adults and 95.7% of youth used English only for the NHIS interview (data not shown).

Household Telephone Access

In 2006–2010, nearly all adults with diabetes had access to a telephone in their home (Figure 8.17), but the type of telephone (i.e., landline or cellular) varied. Regardless of the age at diagnosis, about 20% of adults with diabetes had only a landline telephone compared to 11.1% of adults without diabetes. Phone type was similar for men and women with diabetes, except 82.1% of men with diabetes diagnosed at age ≥20 years had a cell phone in the family compared to 75.8% of women with diabetes diagnosed at age ≥20 years (data not shown). For the age group 20–44 years, 27.8% of adults with diabetes diagnosed at age ≥20 years and 39.5% of adults without diabetes only had cell phone access, but there were no differences by diabetes status in the 45–64 years (15.0% vs. 16.2%) or ≥65 years age groups (7.2% vs. 5.7%). The percentage of cell phone-only households among adults with diabetes diagnosed age ≥20 years varied by race/ethnicity (8.8% of non-Hispanic Asian/Pacific Islander, 11.3% of non-Hispanic white, 15.2% of non-Hispanic black, 22.7% of Hispanic adults). Adults with diabetes diagnosed age ≥20 years compared to adults without diabetes less frequently had a working cell phone in their family (79.0% vs. 87.1%), and lower access was observed in most age, sex, and race/ethnicity categories examined.

FIGURE 8.17

Household Telephone Access Among Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. * 2009–2010

Employment Status in the Past 12 Months

In 2009–2010, adults with diabetes diagnosed age ≥20 years were less likely to be working (43.3%) in the previous 12 months or never worked (6.2%) compared to adults without diabetes (71.8% and 4.4%) (Figure 8.18, Appendix 8.24). Among adults with diabetes diagnosed at age ≥20 years, men were more likely to be working than women (49.0% vs. 37.2%). No significant race/ethnicity differences were noted for working in the last year, except in Hispanic groups who had a higher percentage never working (14.4%) compared to non-Hispanic white (4.0%) and non-Hispanic black (5.3%) groups. Adults in 2009–2010 with diabetes diagnosed at age ≥20 years were less likely to have never worked (6.2%) or be working in the last year (43.3%) than adults in 2006–2010 with diabetes diagnosed at age <20 years (9.8% and 53.7%, respectively).

Employment Status in Prior Week

When queried in 2009–2010, 35.0% of adults with diabetes diagnosed age ≥20 years and 60.3% of adults without diabetes reported working at a paying job in the prior week. The response “not working and not looking for work” was reported by 59.0% and 29.5% of these groups, respectively.

During 2006–2010, the estimates for adults with diabetes diagnosed at age <20 years were 42.3% (working) and 48.7% (not working and not looking) (Appendix 8.25).

Main Reason for Not Working in Prior Week

Among adults with diabetes diagnosed at age ≥20 years, retirement and disability were the main reasons for not working in the prior week (Figure 8.19, Appendix 8.26). In adults without diabetes, the main reasons were retirement or other reasons, especially caring for the family or home. Women, regardless of a diabetes diagnosis, were more likely to report caring for the family or home as the main reason for not working compared to men.

The main reason reported for not working varied by race/ethnicity group. Sixty percent (60.8%) of non-Hispanic white adults with diabetes diagnosed age ≥20 years and 50.0% without diabetes reported being retired compared to 46.8% and 30.1% of non-Hispanic blacks and 47.6% and 20.3% of Hispanics, respectively. Over 18% of Hispanic adults with diabetes and 40% without diabetes reported “taking care of the house or family” as the main reason for not working, which was higher than all the other race/ethnicity groups. Going to school as a reason for not working was reported by <1% of adults with diabetes but varied by race and ethnicity group among those without diabetes, (i.e., 17.6% of non-Hispanic Asian/Pacific Islander without diabetes, 9.0% of non-Hispanic black, 6.8% of Hispanic, 5.3% of non-Hispanic white adults). Being disabled was the main reason reported for not working by 27.4% of non-Hispanic white, 42.2% of non-Hispanic black, 22.0% of Hispanic, and 14.9% of non-Hispanic Asian/Pacific Islander adults with diabetes. A similar pattern but less frequent rate of disability as a reason for not working was reported by adults without diabetes (Appendix 8.26).

A higher percentage of adults in 2006–2010 with diabetes diagnosed age <20 years reported disability as a reason for not working compared to adults in 2009–2010 with diabetes diagnosed age ≥20 years (37.2% vs. 28.5%) (Appendix 8.26).

Type of Employer

Among those who ever worked or currently work, a slightly larger percentage of adults with diabetes diagnosed age ≥20 years worked for government employers and a lower percentage worked for private employers than adults without diabetes (21.5% and 70.4% vs. 16.8% and 74.0%) (Figure 8.20, Appendix 8.27). A higher percentage of women with diabetes diagnosed age ≥20 years worked in State and local government than men with diabetes diagnosed age ≥20 years, similar to the pattern for men and women without diabetes. Men, regardless of diabetes status, were more often self-employed. Within race/ethnicity groups, the employer type was similar for adults with diabetes diagnosed age ≥20 years and adults without diabetes. In 2006–2010, adults with diabetes diagnosed age <20 years were more likely to be working for private employers and less likely to be working for the government, compared to people in 2009–2010 with diabetes diagnosed age ≥20 years.

FIGURE 8.18

Employment in Prior 12 Months Among Adults Age ≥20 Years, by Diabetes Diagnosis and Race/Ethnicity, U.S., 2006–2010. Subgroup analysis by race/ethnicity was not possible for adults diagnosed <20 years because of insufficient sample (more...)

FIGURE 8.19

Main Reason for Not Working in Prior Week Among Adults Age ≥20 Years, by Diabetes Status, Age at Diabetes Diagnosis, and Sex, U.S., 2006–2010. Data are self-reported. Error bars represent 95% confidence intervals. * 2009–2010

FIGURE 8.20

Type of Employer Among Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Data are self-reported. * 2009–2010

Hours Worked when Employed

Among employed adults, the number of hours worked in the prior week was similar for adults with or without diabetes, with approximately 70% reporting working at least 40 hours (Figure 8.21, Appendix 8.28). Among adults with diabetes diagnosed age ≥20 years, 76.4% of men and 63.1% of women worked at least 40 hours in the prior week, which was similar to men and women without diabetes (78.5% and 61.4%). The hours worked were similar by race/ethnicity groups and age groups, except for adults age ≥65 years who worked fewer hours; in this age group, only 42.9% of adults with diabetes and 45.2% of adults without diabetes worked at least 40 hours in the prior week. Approximately 25% of adults with or without diabetes who worked <35 hours in the prior week also reported that they usually worked ≥35 hours per week (Appendix 8.28).

Current Occupations of Workers

Some difference existed in the type of occupations that were reported by adults with diabetes compared to those without diabetes. The percentage of adults with diabetes diagnosed age ≥20 years was higher for health care support, protective service, maintenance, production, transportation, and military occupations compared to adults without diabetes (Appendix 8.29). Office and administrative support jobs (14.6%) and production jobs (11.6%) were the most common occupations among adults with diabetes diagnosed age ≥20 years. Among people without diabetes, the most common occupations reported were sales and related jobs (10.4%) and office and administrative support jobs (14.2%). No significant differences for occupation were observed between adults in 2009–2010 with diabetes diagnosed age ≥20 years and adults in 2006–2010 with diabetes diagnosed age <20 years.

Veteran Status

Diabetes was more frequent among military veterans than among non-veteran adults. Overall, about 35% of men and 1.1% of women with diabetes diagnosed age ≥20 years were military veterans compared with 17.2% of men and 1.3% of women without diabetes (data not shown). Higher percentages of veterans in men with diabetes compared to men without diabetes were observed in the younger age groups, but no significant difference existed in the age group ≥65 years (Figure 8.22).

FIGURE 8.21

Hours Worked in Prior Week Among Employed Adults Age ≥20 Years, by Diabetes Status and Age at Diabetes Diagnosis, U.S., 2006–2010. Hours worked prior week among persons reporting working for pay prior week; working, but not for pay, at (more...)

FIGURE 8.22

Veteran Status Among Men Age ≥20 Years, by Diabetes Status, Age at Diabetes Diagnosis, and Age at Interview, U.S., 2006–2010. Veterans were honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast (more...)

The percentage of men who were veterans varied by race/ethnicity group both in those with diabetes diagnosed age ≥20 years and those without diabetes; the percentage who were veterans remained higher for men with diabetes in each race/ethnicity group compared to those without diabetes (41.0% of non-Hispanic white, 27.8% of non-Hispanic black, 15.8% of Hispanic, 14.1% of Mexican American, 18.6% of other Hispanic, 17.8% of non-Hispanic Asian/Pacific Islander, and 38.7% of non-Hispanic American Indian and Alaska Native groups compared to 20.7%, 15.0%, 5.8%, 5.1%, 7.1%, 6.5%, and 17.6% in men without diabetes within those race/ethnicity groups, respectively) (data not shown). A lower percentage of men in 2006–2010 with diabetes diagnosed age <20 years were veterans compared to men in 2009–2010 with diabetes diagnosed age ≥20 years, and this difference was most pronounced in the 20–44 years age group. In 2006–2010, among adults with diabetes diagnosed age <20 years, nearly 22% of men and <1% of women were military veterans (data not shown).

Reported Health Insurance

In 2009–2010, the percentage reporting health insurance coverage was higher in adults with diabetes diagnosed age ≥20 years than among adults without diabetes (90.4% vs. 81.4%) (Appendix 8.30). The percentage having health insurance was similar for men and women with diabetes; however, among adults without diabetes, a higher percentage of women compared to men had health insurance. Race/ethnicity differences existed among all adults, regardless of diabetes status, and the differences were more pronounced in adults without diabetes. Among adults with diabetes diagnosed age ≥20 years, 80.8% of Hispanic adults with diabetes reported having health insurance coverage which was lower than the 90.0% or higher reported by other race/ethnicity groups. In 2006–2010, 86.1% of adults with diabetes diagnosed age <20 years had health insurance. More detailed health insurance information can be found in Chapter 42 Health Insurance and Diabetes.

Federal Benefits Programs

Federal benefits were commonly received by people with diabetes (Appendix 8.31). These include Social Security or Railroad Retirement benefits, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP), formerly called Food Stamps, and Supplemental Nutrition Program for Women, Infants, and Children (WIC) (detailed data not presented for WIC due to small sample size).

Receipt of Social Security or Railroad Retirement benefits was more common among adults with diabetes diagnosed age ≥20 years than among adults without diabetes (46.6% vs. 17.4%). Among adults age <65 years, a higher percentage of adults with diabetes received these benefits for disability compared to similar age adults without diabetes. A larger percentage of non-Hispanic white adults with diabetes diagnosed age ≥20 years received Social Security or Railroad Retirement benefits compared with adults with diabetes in the other race/Hispanic groups. In 2006–2010, nearly 30% of adults with diabetes diagnosed age <20 years received these benefits.

Receipt of SSI was higher among adults with diabetes (7.1%–8.7%) than among adults without diabetes (2.2%). Over 85% of all SSI recipients received benefits for disability regardless of diabetes category. The percentage receiving SSI benefits varied by racial/ethnic origin and ranged from 5.7% of non-Hispanic white to 11.9% of non-Hispanic black adults with diabetes diagnosed age ≥20 years.

A larger percentage of adults with diabetes diagnosed age ≥20 years received SNAP benefits compared to those without diabetes, including 14.7% versus 8.8% in the 20–44 years age group; 10.3% versus 5.0% in the 45–64 years age group; and 6.4% versus 4.2% in the ≥65 years age group, respectively. Similar patterns for receiving Federal public assistance existed for men and women, except that SNAP benefits were more commonly received by women. Receiving SNAP benefits varied by race/ethnicity groups among adults with diabetes. They were received by 7.0% of non-Hispanic white, 18.4% of non-Hispanic black, 11.1% of Hispanic, and 4.6% of non-Hispanic Asian/Pacific Islander adults with diabetes diagnosed age ≥20 years.

The percentage of adults receiving WIC benefits was significantly lower among adults with diabetes diagnosed at age ≥20 years than among adults without diabetes (0.7% vs. 2.2%) (data not shown). Among women, the estimates were 1.1% and 3.7%. The lower percentage of WIC recipients among adults with diabetes diagnosed age ≥20 years compared to adults without diabetes was observed for non-Hispanic white adults and Hispanic adults, which were the only groups with statistically reliable estimates. Within the age categories (20–44, 45–64, and ≥65 years), there were no differences between adults with diabetes diagnosed age ≥20 years and adults without diabetes (data not shown).