Determinants of health and mortality in undiagnosed diabetes: A nationally representative US adult, 2011–2020

Aim This study examines the determinants of health and mortality associated with undiagnosed diabetes among a nationally representative sample of US adults. Methods Data are from the National Health and Nutrition Examination Survey between 2011 and 2012 and 2019–2020. Diabetes status is categorized into three groups: undiagnosed diabetes, diagnosed diabetes, and no diabetes. Multiple logistic regression is used to estimate the association between undiagnosed diabetes and three domains of risk factors, including sociodemographic and health behavioral and clinical factors. Cox proportional hazards models are performed to compare excess mortality risk between the three groups. Results Young adults, racial minorities, the foreign-born, and individuals with limited access to health care are more likely to be unaware of their diabetes. Moreover, adults without a family history of diabetes and chronic conditions have a higher chance of undiagnosed diabetes. No health behavioral factors are found to be associated with undiagnosed diabetes. Adults with undiagnosed diabetes have a lower risk of all-cause and cardiovascular disease mortality compared to those with diagnosed diabetes, but a higher risk of all-cause mortality than those with no diabetes. Conclusion Targeted public health approaches should address sociodemographic and clinical factors to reduce the burden of undiagnosed diabetes.