Eberhardt Mark S., Casagrande Sarah Stark, Cowie Catherine C.
Dr. Mark S. Eberhardt is Epidemiologist in the Division of National Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
Dr. Sarah Stark Casagrande is Senior Research Analyst at Social & Scientific Systems, Inc., Silver Spring, MD
This chapter presents the demographic and socioeconomic characteristics of people with and without diabetes. The main data source is the National Health Interview Survey (NHIS), with supplemental information from the National Health and Nutrition Examination Survey (NHANES). Estimates from these surveys are nationally representative of the U.S. civilian noninstitutionalized population and are presented for adults age ≥20 years with diabetes diagnosed at either age <20 years or age ≥20 years, adults without diabetes, and when available, youth age <20 years with diabetes and people with undiagnosed diabetes or prediabetes. Overall, people with diabetes were older (76.3% were age ≥50 years compared to 28.2% of people without diagnosed diabetes). In 2009–2010, the current mean age was 46.3 years in people with diabetes diagnosed age <20 years, 60.5 years in people with diabetes diagnosed age ≥20 years, and 45.9 years in people without diabetes. More people with diabetes were male (51.2%) compared to people without diabetes (48.8%). The percentage of male adults among those diagnosed before and after age 20 years was similar (48.9% and 51.4%), and no significant sex differences existed among youth or adults with diabetes diagnosed age <20 years. Adults with diabetes were more frequently non-Hispanic black compared to adults without diabetes. Among those 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% non-Hispanic American Indian and Alaska Native, similar to adults age ≥20 years with diabetes diagnosed age <20 years. In adults without diabetes, the percentages were 69.6%, 11.4%, 13.6%, 4.8%, and 0.6%, respectively. Among adults with diabetes diagnosed age ≥20 years, the mean age at diagnosis was 52.3 years in non-Hispanic white, 49.4 years in non-Hispanic Asian/Pacific Islander, 47.4 years in non-Hispanic black, 47.3 years in Hispanic, and 46.1 in non-Hispanic American Indian and Alaska Native adults. The mean duration of diabetes was longest for adults with diabetes diagnosed age <20 years. In 2006–2010, 77.2% of adults with diabetes diagnosed age <20 years had diabetes for ≥20 years compared to 14.6% of adults in 2009–2010 with diabetes diagnosed age ≥20 years. During 2009–2010, 80.4% of adults with diabetes diagnosed age ≥20 years lived in metropolitan counties compared to 84.3% of adults without diabetes. A similar percentage of people with diagnosed diabetes (53%) and without diabetes (52%) lived in the top 10 most populous states; the rank order of states for the largest percentage of the U.S. population with diabetes was California, Texas, Florida, New York, Ohio, Illinois, Pennsylvania, Michigan, North Carolina, and Georgia. Regionally, a slightly higher percentage lived in the Southern United States (46.1% of adults diagnosed age <20 years, 38.7% of adults diagnosed age ≥20 years, and 35.3% of adults without diagnosed diabetes). In 2009–2010, 83.2% of adults diagnosed age ≥20 years and 83.0% of adults without diabetes were U.S. born, which was similar to the 2006–2010 estimate of 85.9% for adults diagnosed age <20 years. A higher percentage of persons who were age <20 years and had diabetes were U.S. born (96.8%). English was spoken in at least 93% of homes where people with diabetes lived. Over 9% of adults with diabetes in the United States were born in Mexico, Central American, or the Caribbean Islands. Among immigrants, adults with diabetes lived in the United States longer than adults without diagnosed diabetes. For example, 72.3% and 84.2% of adults with diabetes diagnosed before or after age 20 years, respectively, had lived in the United States at least 15 years compared to 58.5% of adults without diagnosed diabetes. Marriage was more common among adults with diabetes diagnosed age ≥20 years compared to adults without diabetes or adults diagnosed age <20 years (59.2%, 56.0%, and 48.9%), but a higher percentage of adults with diabetes diagnosed age ≥20 years lived alone compared to adults without diabetes (21.1% vs. 17.1%). The level of attained education was lower in adults with diabetes compared to those without diabetes (e.g., 17.6% of adults with diabetes diagnosed age ≥20 years, 18.6% of adults with diabetes diagnosed age <20 years, and 31.4% of adults without diabetes graduated with a bachelor’s degree or higher). Among adults with diabetes diagnosed age ≥20 years, fewer women (13.8%) graduated from college than men (21.2%) compared to women (30.4%) and men (32.5%) without diabetes. College graduation was reported by 40.3% of non-Hispanic Asian/Pacific Islander, 20.1% of non-Hispanic white, 13.3% of non-Hispanic black, and 6.1% of Hispanic adults with diabetes diagnosed age ≥20 years, which was lower than their respective groups without diabetes. Adults with diabetes had lower family income (54.3% diagnosed age <20 years, 43.8% diagnosed age ≥20 years, and 32.4% without diagnosed diabetes made <$35,000 annually between 2007 and 2010). Likewise, more adults with diabetes had a Poverty Income Ratio (PIR) <2.00 (49.1%, 38.4%, and 30.7%, respectively). Nearly 25% of non-Hispanic black, Hispanic, and non-Hispanic American Indian and Alaska Native adults lived below poverty (PIR <1.00) regardless of diabetes diagnosis. After considering family income within age and race/ethnicity groups, only adults age 45–64 years with diabetes diagnosed age ≥20 years had lower incomes than similar age adults without diabetes. In 2009–2010, a lower percentage of adults with diabetes diagnosed age ≥20 years reported working in the previous 12 months (43.3%) compared to adults without diabetes (71.8%) or adults in 2006–2010 with diabetes diagnosed age <20 years (53.7%). Over 70% of each group were employed in the private sector, and adults with diabetes diagnosed age ≥20 years had the largest percentage working for the government (21.5%). Being retired was the main reason for not working among adults with diabetes diagnosed age ≥20 years, adults without diabetes, and adults with diabetes diagnosed age <20 years (56.9%, 43.5%, and 38.7%, respectively); and being disabled was more frequently reported by adults in the diabetes groups (28.5%, 15.5%, and 37.2%, respectively). Men with diabetes diagnosed age ≥20 years were more often military veterans than men without diabetes (34.7% vs. 17.2%). Among adults with diabetes diagnosed age ≥20 years, 46.6% received Social Security or Railroad retirement benefits compared to 17.4% of adults without diabetes, and >7% of adults with diabetes received Supplemental Security Income usually due to a disability compared to 2.2% of adults without diabetes.
本章介绍了糖尿病患者和非糖尿病患者的人口统计学和社会经济特征。主要数据来源是美国国家健康访谈调查（NHIS），并辅以美国国家健康和营养检查调查（NHANES）的信息。这些调查的估计数据在全国范围内代表了美国非机构化平民人口，并分别呈现给20岁及以上在20岁之前或20岁及以后被诊断出患有糖尿病的成年人、非糖尿病成年人，以及在数据可得时，20岁以下患有糖尿病的青少年和未被诊断出糖尿病或患有糖尿病前期的人群。总体而言，糖尿病患者年龄更大（76.3%的患者年龄在50岁及以上，而未被诊断出糖尿病的人群中这一比例为28.2%）。在2009 - 2010年，20岁之前被诊断出患有糖尿病的患者当前平均年龄为46.3岁，20岁及以后被诊断出患有糖尿病的患者平均年龄为60.5岁，非糖尿病患者平均年龄为45.9岁。与非糖尿病患者（48.8%）相比，糖尿病患者中男性比例更高（51.2%）。20岁之前和之后被诊断出糖尿病的成年男性比例相似（48.9%和51.4%），20岁以下被诊断出患有糖尿病的青少年或成年人中不存在显著的性别差异。与非糖尿病成年人相比，糖尿病成年人中西班牙裔黑人更为常见。在20岁及以后被诊断出患有糖尿病的人群中，64.4%为非西班牙裔白人，15.8%为非西班牙裔黑人，14.8%为西班牙裔，4.1%为非西班牙裔亚裔/太平洋岛民，0.9%为非西班牙裔美洲印第安人和阿拉斯加原住民，这与20岁之前被诊断出患有糖尿病的20岁及以上成年人情况相似。在非糖尿病成年人中，相应比例分别为69.6%、11.4%、13.6%、4.8%和0.6%。在20岁及以后被诊断出患有糖尿病的成年人中，非西班牙裔白人的诊断平均年龄为52.3岁，非西班牙裔亚裔/太平洋岛民为49.4岁，非西班牙裔黑人为47.4岁，西班牙裔为47.3岁，非西班牙裔美洲印第安人和阿拉斯加原住民成年人为46.1岁。糖尿病诊断年龄小于20岁的成年人糖尿病平均病程最长。在2006 - 2010年，20岁之前被诊断出患有糖尿病的成年人中，77.2%患有糖尿病至少20年，而在2009 - 2010年，20岁及以后被诊断出患有糖尿病的成年人中这一比例为14.6%。在2009 - 2010年期间，20岁及以后被诊断出患有糖尿病的成年人中，80.4%居住在大都市县，而非糖尿病成年人这一比例为84.3%。被诊断出患有糖尿病的人群（53%）和未患糖尿病的人群（52%）中，居住在美国人口最多的前10个州的比例相似；美国糖尿病患者比例最高的州依次为加利福尼亚州、得克萨斯州、佛罗里达州、纽约州、俄亥俄州、伊利诺伊州、宾夕法尼亚州、密歇根州、北卡罗来纳州和佐治亚州。从地区来看，居住在美国南部的比例略高（20岁之前被诊断出患有糖尿病的成年人中占46.1%，20岁及以后被诊断出患有糖尿病的成年人中占38.7%，未被诊断出糖尿病的成年人中占35.3%）。在2009 - 2010年，20岁及以后被诊断出患有糖尿病的成年人中83.2%以及非糖尿病成年人中83.0%在美国出生，这与2006 - 2010年20岁之前被诊断出患有糖尿病的成年人85.9%的估计比例相似。20岁以下患有糖尿病的人群中，美国出生的比例更高（96.8%）。至少93%的糖尿病患者居住家庭使用英语交流。在美国，超过9%的糖尿病成年人出生于墨西哥、中美洲或加勒比群岛。在移民中，患有糖尿病的成年人在美国居住的时间比未被诊断出患有糖尿病的成年人更长。例如，20岁之前或之后被诊断出患有糖尿病的成年人中，分别有72.3%和84.2%在美国居住至少15年，而未被诊断出患有糖尿病的成年人这一比例为58.5%。与非糖尿病成年人或20岁之前被诊断出患有糖尿病的成年人（56.0%和48.9%）相比，20岁及以后被诊断出患有糖尿病的成年人中结婚更为普遍（59.2%），但20岁及以后被诊断出患有糖尿病的成年人中独自生活的比例高于非糖尿病成年人（21.1%对1)。与没有糖尿病的成年人相比，患有糖尿病的成年人所受教育程度较低（例如，20岁及以后被诊断出患有糖尿病的成年人中17.6%、20岁之前被诊断出患有糖尿病的成年人中18.6%以及没有糖尿病的成年人中31.获得学士学位或更高学位）。在20岁及以后被诊断出患有糖尿病的成年人中，大学毕业的女性（13.8%）少于男性（21.2%），而没有糖尿病的女性（30.4%）和男性（32.5%）情况则相反。在20岁及以后被诊断出患有糖尿病的成年人中，40.3%的非西班牙裔亚裔/太平洋岛民、20.1%的非西班牙裔白人、13.3%的非西班牙裔黑人和6.1%的西班牙裔报告大学毕业，这低于各自无糖尿病组人群的比例。患有糖尿病的成年人家庭收入较低（2007 - 2010年期间，20岁之前被诊断出患有糖尿病的成年人中54.3%、20岁及以后被诊断出患有糖尿病的成年人中43.8%以及未被诊断出患有糖尿病的成年人中32.4%年收入低于35,000美元）。同样，患有糖尿病的成年人中贫困收入比率（PIR）低于21.00的比例更高（分别为49.1%、38.4%和30.7%）。无论是否被诊断出患有糖尿病，近25%的非西班牙裔黑人、西班牙裔以及非西班牙裔美洲印第安人和阿拉斯加原住民成年人生活在贫困线以下（PIR <1.00）。在按年龄和种族/族裔群体考虑家庭收入后，只有20岁及以后被诊断出患有糖尿病的45 - 64岁成年人收入低于同龄未患糖尿病的成年人。在2009 - 201年，20岁及以后被诊断出患有糖尿病的成年人中，报告在过去12个月工作的比例（43.3%）低于非糖尿病成年人（71.8%）或2006 - 2010年20岁之前被诊断出患有糖尿病的成年人（53.7%）。每组中超过70%受雇于私营部门，20岁及以后被诊断出患有糖尿病的成年人中为政府工作的比例最高（21.5%）。退休是20岁及以后被诊断出患有糖尿病的成年人、非糖尿病成年人以及20岁之前被诊断出患有糖尿病的成年人不工作的主要原因（分别为56.9%、43.5%和38.7%）；糖尿病组成年人中因残疾而不工作的比例更高（分别为28.5%、15.5%和37.2%）。20岁及以后被诊断出患有糖尿病的男性中退伍军人的比例高于未患糖尿病的男性（34.7%对17.2%）。在20岁及以后被诊断出患有糖尿病的成年人中，46.6%领取社会保障或铁路退休福利，而非糖尿病成年人这一比例为17.4%，超过7%的糖尿病成年人领取补充保障收入，通常是由于残疾，而非糖尿病成年人这一比例为2.2%。
