Educational attainment and type 2 diabetes mellitus in the United States: Effect modification by race/ethnicity and sex in the 2022 Behavioral Risk Factor Surveillance System

Abstract Background Type 2 diabetes mellitus (T2DM) is a leading cause of death and excess healthcare expenditures in the United States. Higher educational attainment is associated with reduced risk for both diabetes onset and diabetes-related mortality. The purpose of this study was to investigate whether the relationship between educational attainment and rates of T2DM varies by race/ethnicity and sex in the United States. Methods We evaluated whether the relationship between educational attainment and rates of T2DM in the U.S. 2022 Behavioral Risk Factor Surveillance System ( n = 277,940) was moderated by race/ethnicity. Follow-up analyses examined moderation by sex. Models were adjusted for sociodemographic factors, body mass index, and health behaviors. Results In both non-Hispanic (NH) White and Hispanic adults, higher educational attainment was associated with lower rates of T2DM. The protective effects of education were stronger in Hispanics compared to Whites, especially in Hispanic men versus NH White men. There was no association between education and T2DM among individuals who identified as NH Black, NH Asian, or NH American Indian or Alaska Native. Conclusions These findings are consistent with previous research demonstrating racial/ethnic heterogeneity in the educational gradient in health outcomes. Further work is needed to better understand and develop interventions to address racial/ethnic disparities in the influence of educational attainment on T2DM.