Islet Autoantibody Patterns Vary by Race and Ethnicity and Area Deprivation Index for Individuals at Risk for Type 1 Diabetes

OBJECTIVE Islet autoantibody positivity (AB+) has not been evaluated across different race, ethnicity, and socioeconomic deprivation categories in individuals at risk for type 1 diabetes. We examined data from TrialNet of people screened for ABs and evaluated patterns by race and ethnicity and socioeconomic deprivation. RESEARCH DESIGN AND METHODS This analysis included 139,963 relatives of people with type 1 diabetes screened by TrialNet between 9 January 2012 and 31 December 2022. Race and ethnicity were categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic other. Home addresses were used to assign deprivation, ranging from least deprived (1) to most deprived (100), analyzed in quintiles. Descriptive and multivariate analyses assessed associations among race and ethnicity, deprivation, and AB+, adjusting for age and protocol period. RESULTS Single AB+ (SAB+) and multiple AB+ (MAB+) varied by age, race and ethnicity, and deprivation. Younger individuals had increased odds of MAB+ and decreased odds of SAB+. Non-Hispanic Black participants had significantly higher odds of AB+ (adjusted odds ratio 1.44 [95% CI 1.29, 1.62]), SAB+ (1.59 [1.38, 1.85]), and MAB+ (1.26 [1.06, 1.51]), while Hispanic individuals had higher odds of SAB+ (1.26 [1.15, 1.39]) and lower odds of MAB+ (0.81 [0.72, 0.91]) compared with non-Hispanic White individuals. Lowest deprivation was associated with higher odds of MAB+ (1.21 [1.06, 1.37]) but not SAB+. CONCLUSIONS AB+ patterns vary by race, ethnicity, and deprivation. Screening and prevention strategies should be designed to identify individuals at risk based on these factors to enable equitable risk stratification and access to diabetes preventive therapies.