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July 10, 2026PLoS ONEOpen Access

Heterogeneous associations of socioeconomic status with metabolic disease in racial and ethnic subgroups in the United States: A cross-sectional cohort study in NHANES and All Of Us

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Why the study?

Whether the associations of improved socioeconomic status with improved health are uniform across US racial and ethnic subpopulations was unknown.

Does the association between socioeconomic status and metabolic disease vary across racial and ethnic subgroups in the United States?

Population

Adult participants in NHANES 1999-2018 and the All of Us cohort v7

Comparison

SES measures (education and income) across self-reported race and ethnicity subgroups

Design

Cross-sectional cohort study

Key result

Higher socioeconomic status was associated with lower rates of type 2 diabetes and obesity in non-Hispanic White and Asian adults, but associations were smaller or reversed in other racial groups.

Authors

SCSara J. CromerJGJulie E GervisSBSherri‐Ann M. Burnett‐Bowie

Discussion

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Overview

Racial differences in SES-metabolic associations highlight disparities; hypothesis-generating and should not yet change practice.

Key Points

  • This research investigates how socioeconomic status (SES) affects metabolic diseases like type 2 diabetes and obesity across different racial and ethnic groups in the U.S.
  • Analyzed data from NHANES (1999–2018) and All of Us cohort v7.
  • Used logistic regression to assess associations between SES (education and income) and health outcomes.
  • Examined race-by-SES interactions and non-linear effects.
  • Higher SES is linked to lower rates of type 2 diabetes and obesity in non-Hispanic White and Asian participants, but less so in non-Hispanic Black and other groups.
  • Age-adjusted T2D and obesity rates were highest in non-Hispanic Black and Mexican American groups with lower SES.
  • Different patterns of association (linear, threshold, or U-shaped) between SES measures and diseases noted across racial groups.

Study Design

Type

Cross-Sectional

Multicenter

Yes

Structured PICO

Does the association between socioeconomic status and metabolic disease vary across racial and ethnic subgroups in the United States?

P
Population
Adult participants from the NHANES 1999-2018 and All of Us cohorts evaluated for the association between socioeconomic status and metabolic disease across racial and ethnic subgroups.
E
Exposure
Higher socioeconomic status (measured by educational attainment and income)
C
Comparator
Lower socioeconomic status
O
Outcome
Prevalence of type 2 diabetes (T2D) and obesity

The association between socioeconomic status and metabolic diseases like T2D and obesity is highly heterogeneous across racial and ethnic groups, suggesting clinical risk algorithms incorporating SES must account for this variability to prevent biased estimates.

Cite This Study

Cromer et al. (2026) conducted a cross-sectional in Type 2 diabetes and obesity. Socioeconomic status (education and income) vs. Lower socioeconomic status was evaluated on Type 2 diabetes and obesity prevalence. Higher socioeconomic status was associated with lower rates of type 2 diabetes and obesity in non-Hispanic White and Asian adults, but associations were smaller or reversed in other racial groups.

synapsesocial.com/papers/6a508e5b6eeac72a437a134dhttps://doi.org/10.1371/journal.pone.0351075
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