Experiences of discrimination and incident type 2 diabetes mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA)

Kara M. Whitaker, Susan A. Everson-Rose, James S. Pankow, Carlos J. Rodriguez, Tené T. Lewis, Kiarri N. Kershaw, Ana V. Diez Roux, Pamela L. Lutsey

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62 Scopus citations


Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discriminationdiabetes relationship.

Original languageEnglish (US)
Pages (from-to)445-455
Number of pages11
JournalAmerican journal of epidemiology
Issue number4
StatePublished - Aug 15 2017

Bibliographical note

Funding Information:
Author affiliations: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Kara M. Whitaker, James S. Pankow, Pamela L. Lutsey); Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (Susan A. Everson-Rose); Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota (Susan A. Everson-Rose); Division of Public Health Sciences, Department of Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina (Carlos J. Rodriguez); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Tené T. Lewis); Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Kiarri N. Kershaw); and Department of Epidemiology, School of Public Health, Drexel University, Philadelphia, Pennsylvania (Ana V. Diez Roux). This work was supported by the National Heart, Lung, and Blood Institute (grants N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, and T32 HL007779 to K.M.W) and the National Center for Research Resources (grants UL1-TR-000040 and UL1-TR-001079).

Publisher Copyright:
© The Author(s) 2017.


  • Multi-Ethnic Study of Atherosclerosis (MESA)
  • discrimination
  • obesity
  • race/ethnicity
  • stress
  • type 2 diabetes mellitus


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