Social Determinants of Health among Chinese Americans at Risk for Diabetes: Cross-Sectional Baseline Analysis of the INCLUDE Mobile Diabetes Prevention Clinical Trial (Preprint)

BACKGROUND Prediabetes is common in the U.S., and adverse social determinants of health (SDOH) are known to undermine diabetes prevention. Chinese Americans experience a disproportionately high prevalence of prediabetes, yet SDOH profiles for this population remain understudied. OBJECTIVE This study assessed SDOH among Chinese Americans at risk for diabetes and examined associations between sociodemographic characteristics and SDOH barriers. METHODS We conducted a cross-sectional analysis of baseline survey data from the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study, a randomized controlled trial of a culturally and linguistically tailored mobile diabetes prevention intervention for Chinese Americans. Participants at risk for diabetes were enrolled between April 2023 and June 2024 in New York City (N = 150). Measures included in the analyses were a 14-item SDOH scale (range 0-14, with higher scores indicating more barriers) and sociodemographic characteristics. We used bivariable logistic regression models to examine associations between sociodemographic factors and the SDOH scale, followed by a multivariable ordinal regression model adjusting for age, sex, years of U.S. residence, English proficiency, education, marital status, employment status, and annual household income. RESULTS Participants had a mean age of 49.95 years (SD: 12.59). Most were women (124/150, 82.7%), born outside the U.S. (149/150, 99.3%), and reported speaking English less than very well (132/150, 88.0%). Among respondents to the SDOH items (n = 149), the mean SDOH score was 2.44 (SD: 2.32), and 81.9% (122/149) reported at least one SDOH barrier. The 3 most frequently reported barriers were need for improving English, reading, or educational attainment (77/149, 51.7%), experiences of racial discrimination (49/149, 32.9%), and adverse housing conditions (38/149, 25.5%). In multivariable analyses, female sex (vs. male; OR = 4.00, 95% CI: 1.72-10.00, P = .001) and unemployment (vs. employed; OR = 2.54, 95% CI: 1.01-6.50, P = .049) were associated with higher SDOH scores. CONCLUSIONS SDOH-related barriers were prevalent among Chinese Americans at risk for diabetes. Diabetes prevention efforts should incorporate routine SDOH screening and structured resource navigation or referral pathways, with particular attention to subgroups at higher risk, including women and unemployed individuals. CLINICALTRIAL NCT05492916 INTERNATIONAL REGISTERED REPORT RR2-10.2196/65455