The intersection of place and health: examining the association of social determinants of health and diabetes in children and adolescents in Florida

Diabetes is a leading cause of mortality globally and ranks as the eighth leading cause of death in the United States. Affecting approximately 8.9% of Americans, diabetes imposes a substantial public health burden. Florida lies within the “Diabetes Belt,” a region identified by the Centers for Disease Control and Prevention where residents face an elevated risk of diabetes. Over the past two decades, the incidence of type 1 (T1D) and type 2 diabetes (T2D) in children and adolescents has risen sharply, with distinct etiological differences. Diabetes-related complications progress more rapidly in children than in adults, and population demographics, geographic factors, and built environment disparities differentially influence disease prevalence and progression. This study leverages real-world health data from OneFlorida + to examine racial, ethnic, and geographic disparities in T1D and T2D prevalence in children and adolescents and the impact of Social Determinants of Health (SDoH) on the prevalence of T1D and T2D. T1D was most common among non-Hispanic White children (38.7%), whereas T2D was more common among non-Hispanic African American children (39.7%). Socioeconomic disparities at the ZCTA level revealed that T2D-associated ZCTAs had lower median household incomes and higher poverty rates. T1D prevalence was highest in north-central and southeast Florida, while T2D prevalence was elevated in north-central, west-central, and southwest regions. SDoH variables were significantly associated with diabetes prevalence, with spatial heterogeneity observed only in the geographically weighted regression for T1D. Significant racial, ethnic, geographic, and socioeconomic disparities exist in the prevalence of diabetes in children and adolescents, with north-central Florida emerging as a high-burden region.