Investigating Racial and Ethnic Variation in High Sensitivity C-Reactive Protein Levels Among Individuals with Prediabetes

Background: High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation linked to chronic health conditions, including prediabetes. Many factors, including social determinants of health such as socioeconomic status, food insecurity, chronic stress and many others, can affect hs-CRP levels. Given the well-documented health disparities across racial and ethnic minority groups regarding social determinants of health, it’s crucial to investigate how hs-CRP levels vary in people with prediabetes to uncover possible contributing factors that could predispose an individual to develop prediabetes and its sequelae. This study investigated whether hs-CRP levels differ among racial and ethnic groups with prediabetes, potentially reflecting the role of health inequalities. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were utilized for adults age 18 and older with prediabetes. Participants were grouped into racial and ethnic minority populations (Mexican American, Other Hispanic, Non-Hispanic Black, Non-Hispanic Asian, and Other Race) and non-minority populations (Non-Hispanic White). A Wilcoxon rank-sum test was performed to compare the distribution of hs-CRP levels after adjusting for sample weights. Further subgroup analyses were conducted comparing CRP levels by minority status for the following subgroups: sex, insurance status, and education status. Results: In the unweighted sample, racial and ethnic minority populations had significantly higher hs-CRP levels than non-minority populations (p=0.03). However, after adjusting for survey weights, this difference approached but did not reach statistical significance (p=0.09). The median hs-CRP level for minority populations was 2.99 (IQR: 1.22, 5.74), compared to 1.94 (IQR: 1.03, 4.67) in non-minority populations (p = 0.09). Non-Hispanic Black individuals had the highest hs-CRP levels, with a median hs-CRP level of 3.93. CRP levels only seemed to significantly differ in the combined subgroup of high school graduates and individuals with some college or AA degree. In this subgroup, the minority group had higher median CRP levels than the non-minority group (3.10 versus 2.10; p-value = 0.0048). Conclusion: Our findings present disparities in hs-CRP levels among different racial and ethnic populations with prediabetes, especially in Non-Hispanic Black individuals. Understanding and addressing possible social determinants of health, such as food insecurity or chronic stress, is essential for accurately assessing individual risk and implementing patient-centered preventive strategies.