Improving socioeconomic status is not associated with comparable reductions in rates of type 2 diabetes and obesity across all racial and ethnic groups in the United States, according to a new study published in an open access journal on July 8, 2026. Pro Swan By Sarah Cromer of Harvard Medical School in the United States.
Unfavorable socio-economic status (SES) is associated with negative health outcomes, and many researchers, clinicians, and risk calculators assume that improving SES will result in equal health benefits for all populations.
In the new study, researchers analyzed data from 54,991 adult participants in the U.S. National Health and Nutrition Examination Survey (NHANES) and 404,990 participants in the U.S. National Health and Nutrition Examination Survey from 1999 to 2018. all of us (AoU) Cohort. Researchers assessed the association between education, income, and prevalence of type 2 diabetes (T2D) and obesity.
Age-adjusted rates of T2D and obesity were generally highest in participants with lower SES and in non-Hispanic black, Mexican American, other Hispanic, and other/multiracial participants. Using adjusted models to examine how SES differed in prevalence for different racial and ethnic groups, the researchers found that higher education was associated with a 12% reduction in T2D prevalence among non-Hispanic white participants (OR 0.88, 95% CI 0.85-0.91), but only a 4% reduction among non-Hispanic black participants (OR 0.96, 95% CI). 0.92 to 0.99). Similarly, higher income was protective against obesity among non-Hispanic white participants (OR 0.97, 95% CI 0.95 to 0.996) but was associated with higher obesity rates among non-Hispanic black participants (OR 1.05, 95% CI 1.01 to 1.08). Effects also vary depending on the dataset and SES measure used. For example, education is associated with metabolic disease differently than income, and these associated measures capture different risks.
The cross-sectional design of this study means that causality cannot be proven, and the AoU cohort is subject to selection bias, particularly with non-Hispanic Asian participants exhibiting very high educational attainment. Despite these limitations, the authors conclude that the direction, magnitude, and shape of associations between SES and metabolic disease are heterogeneous across racial and ethnic groups in the United States, and that treating these associations as uniform may obscure important differences, particularly among minority populations.
Sarah Cromer added: ”Improvements in education and income are, on average, associated with lower rates of diabetes and obesity, but the extent of improvement varies widely by race. Overall, black, Hispanic, and Asian individuals in the United States experience reduced protective effects of higher education and income compared to whites.. ”
”It has long been known that lower education and income are associated with poorer health outcomes. Understanding how education and income interact with health in all communities is now increasingly important. In an effort to not only promote precision medicine but also prevent race-based medical decision-making, medical risk calculators are beginning to include measures such as education and income to help doctors recommend treatments. If we do not fully understand how these factors affect health or ignore differences between communities, these calculation tools can lead to worsening health disparities.. ”
Sirag Patel added:Socioeconomic status alone does not provide a complete picture of health risk; how it is measured is important. These findings set clearer standards for how researchers should capture and report these variables so that predictive tools are accurate across patients.”
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Reference magazines:
Cromer, S.J.; others. (2026) Heterogeneous associations of socioeconomic status and metabolic disease among racial and ethnic subgroups in the United States: A cross-sectional cohort study in NHANES and All Of Us. PLoS One. DOI: 10.1371/journal.pone.0351075. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0351075
