Abstract Body: Introduction: Self-reported health is an indicator of overall well-being, encompassing physical, mental, and social health. It predicts future morbidity and mortality. Among individuals with diabetes in the United States, most prior studies focused on diabetes treatment and control and rates of complications, but data on patient-reported outcomes such as self-reported health are lacking. The objective of this study was to characterize trends and disparities in self-reported health among US adults with diabetes.

Methods: We performed serial cross-sectional analyses of adults aged ≥20 years with self-reported diabetes who participated in the 2001-2018 National Health and Nutrition Examination Survey (NHANES). Self-reported health status was categorized as high (good/very good/excellent) or low (poor/fair). We examined trends in the prevalence of high self-reported health, overall and by subgroups defined by age, race and ethnicity, income, education, and insurance. All analyses accounted for the complex survey design and were weighted to generate nationally representative estimates.

Results: We included 5306 adults with diabetes (mean age, 60 years; 49% female; 63% self-identified as Non-Hispanic White; 15% Non-Hispanic Black; 15% Hispanic). Over the 18-year study period, the prevalence of high self-reported health was stable: 58.3% (95% CI 53.1 to 63.3%) in 2001-2004 to 64.0% (95% CI 59.3 to 68.5%) in 2017-2018, p-trend=0.096 (Figure 1A). A significant increase in the prevalence of high self-reported health was observed in adults aged ≥ 65 years (55.8% [95% CI: 49.6-61.8%] to 68.9% [95% CI: 60.6-76.1%], p-trend=0.002, Figure 1B). Disparities by race/ethnicity have widened over time, with significantly lower prevalence of high self-reported health in Hispanic adults compared to non-Hispanic White adults in 2017-2018 (47.7% vs. 67.7%, p=0.004, Figure 2A). Disparities in self-reported health by income, education, and insurance have also widened (Figure 2B, 3A, and 3B).

Conclusions: Self-reported health has improved among older, but not younger, adults with diabetes in the past two decades. There were persisting or worsening disparities in self-reported health by race/ethnicity and socioeconomic status. Further research is needed to understand the factors contributing to overall well-being across age groups. Persistent disparities in self-reported health call for targeted programs that prioritize marginalized groups.