The Association between Depression and Diabetes and Associated Risk Factors by Racial/Ethnic Status among Adults in Arizona: Arizona Behavioral Risk Factor Surveillance System, 2014-2017

Objective: The purpose of our study was to examine the association between depression with diabetes, current smokers, and overweight or obesity among adults in four racial/ethnic groups: non-Hispanic whites (NHWs), non-Hispanic African Americans/blacks (NHAA/blacks), Hispanics, and American Indians/Alaskan Natives (AI/ANs), in Arizona. Methods: Data from the 2014-2017 Arizona Behavioral Risk Factor Surveillance System was used to examine the association between self-reported provider-diagnosed depression and self-reported provider-diagnosed diabetes and associated risk factors for each racial/ethnic group (n=31,671). The analysis was extended to test whether current smoking status or overweight or having obesity status modified the association between depression and diabetes among all Arizona adults. Weighted adjusted prevalence ratios (APRs) accounting for potential confounders were estimated using Cox’s proportional hazards regression analysis. Results: For all Arizona adults after adjusting for potential confounders, the prevalence of diabetes (APR =1.60: 95% confidence interval=1.43-1.72), current smoking status (APR=1.04: 1.02-1.07), and overweight or obesity status (APR=1.07:1.03-1.11) was greater among adults with depression versus without depression. For NHWs (APR=1.63:1.47-1.80), Hispanics (APR=1.71:1.39-2.12), and AI/ANs (APR=1.44:1.11-2.05) the prevalence of diabetes was greater among adults with depression versus without depression. In addition, the association between depression and diabetes was greater for current smokers and those overweight or with obesity than their counterparts in all Arizona adults (p<0.05 for both). Conclusion: Depression was associated with diabetes among all Arizona adults and NHWs, Hispanics, and AI/ANs. Current smoking status and overweight/obese status modified the association between depression and diabetes for all Arizona adults.