Neighborhood disadvantage and chronic disease management
Neighborhood disadvantage and chronic disease management
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DOI：
10.1111/1475-6773.13092
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发表时间：
2019-02-01
影响因子：
3.4
通讯作者：
Trivedi, Amal N.
中科院分区：
文献类型：
--
作者：
Durfey, Shayla N. M.;Kind, Amy J. H.;Trivedi, Amal N.
目的评估社区劣势的综合指标--区域残疾指数（ADI）与医疗保险优势（MA）人群中血压、糖尿病和胆固醇控制之间的关系。2013年医疗保险医疗效果数据和信息集，医疗保险注册数据和邻里劣势指标的二次分析。研究设计我们测试了邻里劣势与中间健康结果的关联。广义估计方程用于调整地理和个人因素，包括地区，性别，种族/民族，双重资格，残疾和农村。数据通过ZIP+4链接，代表可以链接到人口普查区块组的紧凑地理区域。与居住在最不贫困社区的登记者相比，居住在最贫困社区的登记者控制血压的可能性低5个百分点（P < 0.05），控制糖尿病的可能性低6.9个百分点（P < 0.05），控制胆固醇的可能性低9.9个百分点（P < 0.05）。调整减弱了这种关系，但这种联系仍然存在。结论ADI是糖尿病和胆固醇控制的一个强有力的独立预测因子，是血压控制的一个中度预测因子，可用于跟踪MA人群的邻里水平差异和针对性的以健康为中心的干预措施。
Objective To assess the relationship between a composite measure of neighborhood disadvantage, the Area Deprivation Index (ADI), and control of blood pressure, diabetes, and cholesterol in the Medicare Advantage (MA) population. Data Sources Secondary analysis of 2013 Medicare Healthcare Effectiveness Data and Information Set, Medicare enrollment data, and a neighborhood disadvantage indicator. Study Design We tested the association of neighborhood disadvantage with intermediate health outcomes. Generalized estimating equations were used to adjust for geographic and individual factors including region, sex, race/ethnicity, dual eligibility, disability, and rurality. Data Collection Data were linked by ZIP+4, representing compact geographic areas that can be linked to Census block groups. Principal Findings Compared with enrollees residing in the least disadvantaged neighborhoods, enrollees in the most disadvantaged neighborhoods were 5 percentage points (P < 0.05) less likely to have controlled blood pressure, 6.9 percentage points (P < 0.05) less likely to have controlled diabetes, and 9.9 percentage points (P < 0.05) less likely to have controlled cholesterol. Adjustment attenuated this relationship, but the association remained. Conclusions The ADI is a strong, independent predictor of diabetes and cholesterol control, a moderate predictor of blood pressure control, and could be used to track neighborhood-level disparities and to target disparities-focused interventions in the MA population.