Socially Assigned Race and Diabetes: Findings from the Arizona Behavioral Risk Factor Surveillance System, 2013–2014

  • Jourdyn A. Lawrence
  • Kellee WhiteEmail author
  • Jason L. Cummings
  • James W. Hardin
  • Myriam E. Torres


Socially assigned race, the racial/ethnic categorization of individuals by others, may serve as the basis for differential or unfair treatment. Latinxs are commonly socially assigned to a race/ethnicity with which they do not self-identify. However, it is unclear the degree to which self-identified Latinxs who are socially assigned as white or Latinx may differentially predict health outcomes beyond general health status and healthcare utilization. We examine the association between socially assigned race and type 2 diabetes mellitus (T2DM). Data from the Arizona’s Behavioral Risk Factor Surveillance System (2013, 2014) was used in a cross-sectional analysis (restricted to Latinxs and non-Hispanic whites; N = 8370) to examine the association between self-identified (SI) and socially assigned (SA) race/ethnicity agreement and T2DM. Latinxs were categorized according to SI-SA race/ethnicity agreement: discordant (SI-SA, different) and concordant (SI-SA, same). T2DM was based on self-reported physician diagnosis. Data were analyzed using Poisson regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Latinxs comprised 28.5% of our sample, of which, 18.5% was discordant and 81.5% was concordant. In fully adjusted models, concordant Latinxs were more likely to have T2DM than whites (aPR 2.01, 95% CI 1.44, 2.82). There were no significant differences in T2DM between discordant Latinxs and whites. Our results suggest that socially assigned race is an understudied determinant of health and may further understanding of the impact of racial stratification on Latinx health inequities. Additional research examining socially assigned race and other health outcomes are warranted to gain further insight of the biological impact of racialized lived experiences.


Socially assigned race Latinos Diabetes Discrimination Health disparities 


Funding Information

This study was funded by the University of South Carolina Social Science Provost Grant (USC:11520).

Compliance with Ethical Standards

Ethical Standards

Each author declares that he or she has no conflict of interest. This article does not contain any studies with human participants performed by any of the authors. The original data collection was reviewed and approved by the CDC Institutional Review Board. The University of South Carolina Institutional Review Board approved this research as exempt (Pro00058016). Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. National Diabetes Statistics Report: estimates of diabetes and its burden in the United States, 2014. Atlanta: US Department of Health and Human Services; 2014. p. 2009–12.Google Scholar
  2. 2.
    Caballero AE. Cardiometabolic risk in the Latino/Hispanic population. Current Cardiovascular Risk Reports. 2013;7(6):433–7.CrossRefGoogle Scholar
  3. 3.
    Pager D, Shepherd H. The sociology of discrimination: racial discrimination in employment, housing, credit, and consumer markets, in Annual Review of Sociology. 2008, Annual Reviews: Palo Alto. p. 181–209.Google Scholar
  4. 4.
    Borrell LN, Crawford ND, Dallo FJ, Baquero MC. Self-reported diabetes in Hispanic subgroup, non-Hispanic black, and non-Hispanic white populations: National Health Interview Survey, 1997-2005. Public Health Rep. 2009;124(5):702–10.CrossRefGoogle Scholar
  5. 5.
    Arroyo-Johnson C, et al. Racial and ethnic heterogeneity in self-reported diabetes prevalence trends across Hispanic subgroups, National Health Interview Survey, 1997-2012. Prev Chronic Dis. 2016;13:10.CrossRefGoogle Scholar
  6. 6.
    Borrell LN, Crawford ND, Dallo FJ. Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003. Public Health Rep. 2007;122(5):616–25.CrossRefGoogle Scholar
  7. 7.
    LaVeist-Ramos TA, et al. Are black Hispanics black or Hispanic? Exploring disparities at the intersection of race and ethnicity. J Epidemiol Community Health. 2012;66(7):5.CrossRefGoogle Scholar
  8. 8.
    Vargas ED, Sanchez GR, Kinlock BL. The enhanced self-reported health outcome observed in Hispanics/Latinos who are socially-assigned as white is dependent on nativity. J Immigr Minor Health. 2015;17(6):1803–10.CrossRefGoogle Scholar
  9. 9.
    Garcia JA, Sanchez GR, Sanchez-Youngman S, Vargas ED, Ybarra VD. Race as lived experience: the impact of multi-dimensional measures of race/ethnicity on the self-reported health status of Latinos. Du Bois Review-Social Science Research on Race. 2015;12(2):349–73.CrossRefGoogle Scholar
  10. 10.
    Jones CP, et al. Using “socially assigned race” to probe white advantages in health status. Ethn Dis. 2008;18(4):496–504.PubMedGoogle Scholar
  11. 11.
    Vargas N, Kingsbury J. Racial identity contestation: mapping and measuring racial boundaries. Sociol Compass. 2016;10(8):718–29.CrossRefGoogle Scholar
  12. 12.
    Vargas ED, Winston NC, Garcia JA, Sanchez GR. Latina/o or Mexicana/o? The relationship between socially assigned race and experiences with discrimination. Sociol Race Ethn. 2016;2(4):498–515.CrossRefGoogle Scholar
  13. 13.
    Roth WD. The multiple dimensions of race. Ethn Racial Stud. 2016;39(8):1310–38.CrossRefGoogle Scholar
  14. 14.
    Cormack DM, Harris RB, Stanley J. Investigating the relationship between socially-assigned ethnicity, racial discrimination and health advantage in New Zealand. PLoS One. 2013;8(12):10.CrossRefGoogle Scholar
  15. 15.
    Vargas N, Stainback K. Documenting contested racial identities among self-identified Latina/os, Asians, Blacks, and Whites. Am Behav Sci. 2016;60(4):442–64.CrossRefGoogle Scholar
  16. 16.
    MacIntosh T, Desai MM, Lewis TT, Jones BA, Nunez-Smith M. Socially-assigned race, healthcare discrimination and preventive healthcare services. PLoS One. 2013;8(5):e64522.CrossRefGoogle Scholar
  17. 17.
    Stepanikova I, Oates GR. Dimensions of racial identity and perceived discrimination in health care. Ethn Dis. 2016;26(4):501–12.CrossRefGoogle Scholar
  18. 18.
    Harris RB, Cormack DM, Stanley J. The relationship between socially-assigned ethnicity, health and experience of racial discrimination for Maori: analysis of the 2006/07 New Zealand Health Survey. BMC Public Health. 2013;13.Google Scholar
  19. 19.
    Perreira KM, Telles EE. The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Soc Sci Med. 2014;116:241–50.CrossRefGoogle Scholar
  20. 20.
    Pabon-Nau LP, Cohen A, Meigs JB, Grant RW. Hypertension and diabetes prevalence among US Hispanics by country of origin: the National Health Interview Survey 2000-2005. J Gen Intern Med. 2010;25(8):847–52.CrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. Summary Data Quality Report. 2013:2014 Available from:
  22. 22.
    Centers for Disease Control and Prevention. Behavioral risk factor surveillance system 2014 summary data quality report. 2015 3/16/17]; Available from:
  23. 23.
    Li CY, et al. Prevalence of depression among US adults with diabetes - findings from the 2006 behavioral risk factor surveillance system. Diabetes Care. 2008;31(1):105–7.CrossRefGoogle Scholar
  24. 24.
    Casagrande SS, Cowie CC. Trends in dietary intake among adults with type 2 diabetes: NHANES 1988-2012. J Hum Nutr Diet. 2017;30(4):479–89.CrossRefGoogle Scholar
  25. 25.
    Ng E, Vanderloo SE, Geiss L, Johnson JA. Concordance between self-report and a survey-based algorithm for classification of type 1 and type 2 diabetes using the 2011 population-based survey on living with chronic diseases in Canada (slcdc)-diabetes component. Can J Diabetes. 2013;37(4):249–53.CrossRefGoogle Scholar
  26. 26.
    Anderson KF. Diagnosing discrimination: stress from perceived racism and the mental and physical health effects. Sociol Inq. 2013;83(1):55–81.CrossRefGoogle Scholar
  27. 27.
    Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40(1):105–25.CrossRefGoogle Scholar
  28. 28.
    Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(21).Google Scholar
  29. 29.
    Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol. 2008;8(9).Google Scholar
  30. 30.
    Vargas N. Latina/o Whitening? Which Latina/os self-classify as white and report being perceived as white by other Americans? Du Bois Review: Social Science Research on Race. 2015;12(01):119–36.CrossRefGoogle Scholar
  31. 31.
    Reid J, Cormack D, Crowe M. The significance of socially-assigned ethnicity for self-identified Mori accessing and engaging with primary healthcare in New Zealand. Health. 2016;20(2):143–60.CrossRefGoogle Scholar
  32. 32.
    Pew Research Center. Demographic profile of Hispanics in Arizona, 2014. August 1, 2017]; Available from:
  33. 33.
    Lopez G. Hispanics of Mexican origin in the United States. 2013. Accessed 1 Aug 2017.Google Scholar
  34. 34.
    Bowlin SJ, et al. Validity of cardiovascular-disease risk-factors accessed by telephone survey - the behavioral risk factor surveillance survey. J Clin Epidemiol. 1993;46(6):561–71.CrossRefGoogle Scholar
  35. 35.
    Campbell ME, Troyer L. The implications of racial misclassification by observers. Am Sociol Rev. 2007;72(5):750–65.CrossRefGoogle Scholar
  36. 36.
    Garcia EFY, et al. Depression treatment preferences of Hispanic individuals: exploring the influence of ethnicity, language, and explanatory models. J Am Board Fam Med. 2011;24(1):39–50.CrossRefGoogle Scholar
  37. 37.
    Feliciano C. Shades of race: how phenotype and observer characteristics shape racial classification. Am Behav Sci. 2016;60(4):390–419.CrossRefGoogle Scholar
  38. 38.
    Hill ME. Race of the interviewer and perception of skin color: evidence from the multi-city study of urban inequality. Am Sociol Rev. 2002;67(1):99–108.CrossRefGoogle Scholar
  39. 39.
    Office of Management and Budget. Revisions to the standards for classification of federal data on race and ethnicity. Fed Regist. 1997;62:58781–90.Google Scholar
  40. 40.
    Anderson KF, Finch JK. Racially charged legislation and Latino health disparities: the case of Arizona’s S.B. 1070. Sociol Spectr. 2014;34(6):526–48.CrossRefGoogle Scholar
  41. 41.
    Diaz JA, Roberts MB, Goldman RE, Weitzen S, Eaton CB. Effect of language on colorectal cancer screening among Latinos and non-Latinos. Cancer Epidemiol Biomark Prev. 2008;17(8):2169–73.CrossRefGoogle Scholar
  42. 42.
    Grimm KA, Blanck HM. Survey language preference as a predictor of meeting fruit and vegetable objectives among Hispanic adults in the United States, behavioral risk factor surveillance system, 2009. Prev Chronic Dis. 2011;8(6):9.Google Scholar
  43. 43.
    Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet (London, England). 2014;383(9933):1999–2007.CrossRefGoogle Scholar
  44. 44.
    Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.CrossRefGoogle Scholar
  45. 45.
    Bass J, Bailey R, Gieszl S. Arizona behavioral risk factor surveillane system survey 2013. 2014 April 5, 2019]; Available from:
  46. 46.
    Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511.CrossRefGoogle Scholar
  47. 47.
    Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57(8):1152–73.CrossRefGoogle Scholar
  48. 48.
    Jones C. Confronting institutionalized racism. Phylon. 2002;50(1/2):7–22.CrossRefGoogle Scholar
  49. 49.
    Roth WD. Racial mismatch: the divergence between form and function in data for monitoring racial discrimination of Hispanics. Soc Sci Q. 2010;91(5):1288–311.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Social and Behavioral SciencesHarvard T.H Chan School of Public HealthBostonUSA
  2. 2.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  3. 3.Department of Health Services AdministrationUniversity of Maryland College Park School of Public HealthCollege ParkUSA
  4. 4.Department of Sociology and African American StudiesUniversity of South CarolinaColumbiaUSA

Personalised recommendations