Self-Reported Diabetes Prevalence in Asian American Subgroups: Behavioral Risk Factor Surveillance System, 2013–2019

Background: Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians aggregated into a single group, but the Asian American population is heterogenous. Objective: To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention. Design: Serial cross-sectional analysis. Participants: Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA, N=57,001), comprising Asian Indian (N=11,089), Chinese (N=9458), Filipino (N=9339), Japanese (N=10,387), and Korean Americans (N=2843), compared to non-Hispanic White (NHW, N=2,143,729) and non-Hispanic Black (NHB, N=215,957) Americans. Main Measures: Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status. Key Results: Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2–9.3) in NHA, compared to 14.3% (14.0–14.6) in NHB and 10.0% (10.0–10.1) in NHW (p<0.01 for difference). In NHA subgroups overall, DM prevalence was 14.4% (12.6–16.3) in Filipino, 13.4% (10.9–16.2) in Japanese, 10.7% (9.6–11.8) in Asian Indian, 5.1% (4.2–6.2) in Chinese, and 4.7% (3.4–6.3) in Korean Americans (p<0.01). Among those aged ≥65 years, DM prevalence was highest in Filipino (35.0% (29.4–41.2)) and Asian Indian (31.5% (25.9–37.8)) Americans. Adjusted for sex, education, and race/ethnicity-specific obesity category, NHA overall had a 21% higher DM prevalence compared to NHW (prevalence ratio 1.21 [1.14–1.27]), while prevalence ratios were 1.42 (1.24–1.63) in Filipinos and 1.29 (1.14–1.46) in Asian Indians. Conclusions: Adjusted self-reported DM prevalence is higher in NHA compared with NHW. Disaggregating NHA reveals heterogeneity in self-reported DM prevalence, highest in Filipino and Asian Indian Americans.