health disparities; access; obesity; endocrinology; diabetes


Endocrinology, Diabetes, and Metabolism | Health Services Research | Pediatrics


Methods: This study examines the impact of race and rurality on health differences, including prevalence of prediabetes and type 2 diabetes (T2D), among overweight children accessing pediatric endocrine specialty care. Cross-sectional analysis of overweight/obese youth 10 to 18 years of age receiving pediatric endocrinology consultation for weight gain, hyperglycemia, and/or T2D from 2013 to 2016 at a Midwest tertiary pediatric center.

Results: The 722 patients were 42% white, 25% black, 22% Hispanic; 88% lived in urban areas and 12% in rural areas. Rurality was determined using zip code approximation of Rural-Urban Commuting Area (RUCA) codes. After adjusting for confounders, black patients were 2.26 times (95% CI: 1.26 - 4.11; P = 0.007) more likely than white patients to have T2D. White patients were 1.83 times (95% CI: 1.26 - 2.68; P = 0.002) more likely to have normal glucose metabolism than non-white patients. No significant differences were found between urban and rural populations.

Conclusions: Among overweight youth, minorities are more likely to have abnormal glucose metabolism at the time of initial endocrine evaluation compared to white youth. However, rurality does not appear to contribute to the same health disparities. These findings suggest the presence of racial differences in timing of endocrine referrals among overweight children, and underscores the need for future investigation of mechanisms contributing these differences.