Background: Neighborhood socioeconomic status (nSES) has been linked to various health outcomes, including diabetes prevalence; however, the relationship between nSES and diabetes may vary across different racial/ethnic groups.

Objective: To investigate the association between nSES and diabetes in a multi-ethnic population, and to explore potential racial/ethnic differences in this relationship.

Methods: The study analyzed 8609 participants aged >40 years from the ongoing multi-ethnic Food and Microbiome Longitudinal Investigation (FAMiLI), with data collected in 2018—2022. The nSES index was created by principal component analysis of variables from the 2015 American Community Survey. Logistic regression was used to estimate diabetes prevalence by quintiles of nSES, while adjusting for age, gender, race/ethnicity, education, marital status, smoking status, and exercise.

Results: Diabetes prevalence was lowest in Whites (9.9%), while approximately doubled among Non-Whites (21.8% for Asian, 19.1% for Black, 19.6% for Hispanic). Non-Whites had significantly lower nSES index (ranging from -4.62 to 8.66) than Whites (ranging from -3.85 to 8.74). Residence in the lowest nSES quintile (deprived neighborhood) was associated with a higher diabetes risk overall (OR=1.59, 95% CI=1.28—1.96, P=1.9E-05). This association was observed particularly among Whites (OR=2.34, 95% CI=1.61—3.41, P_trend=7.4E-07), with a weaker trend among Non-Whites (OR=1.30, 95% CI=1.01—1.67, P_trend=0.067).

Conclusion: Living in a neighborhood characterized by lower SES was associated with higher diabetes prevalence, particularly for Whites. The association of nSES with diabetes was less pronounced for other racial/ethnic groups; nevertheless, this geographic index can be used to identify areas needing targeted intervention to address health disparities and address equitable outcomes.