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June 7, 2026

2367-P: All-Cause Mortality by Diabetes Phenotype and Race in a Low-Income Population with Diabetes

Key Points

The aim was to quantify all-cause mortality by diabetes phenotype and race in a low socioeconomic status adult cohort.
Mortality follow-up included 16,437 individuals with diabetes and 62,122 without, aged 40-79, recruited mostly from health centers.
Patients were classified by diabetes type and followed for a mean of 14.9 years using multivariable Cox models to compute hazard ratios.
Data was separated by race (African American and White Americans) to assess differences in mortality rates.
53% of the low-income population died during the follow-up period.
Compared to those without diabetes, adjusted hazard ratios for mortality were 3.7 for type 1 diabetes (T1D) and 2.1 for atypical diabetes.
Racial differences in mortality were slight, with hazard ratios for African Americans showing minimal variation compared to White Americans.

Abstract

Introduction and Objective: Due to the absolute requirement of insulin for insulin deficiency in type 1 and other diabetes sub-types, persons of low income, overrepresented by African Americans, are particularly vulnerable to succumbing to the disease. Our objective was to quantify all-cause mortality by diabetes phenotype and race in a low SES adult cohort of African Americans and White Americans. Methods: We conducted a mortality follow up of persons aged 40-79 recruited largely from federally qualified health centers, 16,437 w/ and 62,122 w/out diabetes at cohort entry. Patients diagnosed w/ diabetes before age 30 were classified as: insulin therapy only (presumed type 1 diabetes, T1D, n=449); insulin + an additional hypoglycemic agent (youth/young-adult onset type 2 diabetes, YYA-T2D, n=235); or not on insulin therapy (atypical diabetes, n=591). Those diagnosed w/ diabetes at/after age 30 were classified as having older adult onset type 2 diabetes (AO-T2D, n=15,162). Multivariable Cox models were used to compute HR (95%) CI for mortality by diabetes type and, w/in diabetes, race. Results: Mean age and diabetes duration at start of follow up, respectively, were 50 and 29 yrs for those diagnosed under age 30 and 55 and 8 yrs for AO-T2D; mean age at entry was 52 in those w/out diabetes. During follow-up (mean 14.9 yrs), 53% of the population died; respective annual percentages who died were 6.0, 5.0, 3.5, 3.9 and 2.0. for T1D, YYA-T2D, atypical diabetes, AO-T2D & no diabetes. Compared to those w/out diabetes, respective adjusted HR (95% CI) were 3.7 (3.3-4.1), 2.8 (2.4-3.3), 2.1 (1.8-2.3) and 1.28 (1.24-1.31). Except for YYA-T2D, only small differences in mortality were seen between African Americans and White Americans, w/ racial HR (95% CI) for T1D, YYA-T2D, atypical diabetes and AO-T2D, respectively equal 1.2 (0.9-1.5), 0.6 (0.4-0.9), 1.0 (0.8-1.4) & 1.1 (1.0-1.2). Conclusion: In this population w/ similar low SES & access to health care, African Americans & White Americans age 40-79 w/ diabetes each experienced substantial absolute & relative increases in all-cause mortality. Disclosure R. Conway: None. R. Chauma: None. Funding National Institutes of Health (U01CA202979) and Vanderbilt-Ingram Cancer Center (P30 CA68485).

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