Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records
Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records
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DOI：
10.1016/j.pmedr.2019.100953
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发表时间：
2019-09-01
影响因子：
2.8
通讯作者：
Buehler, James W.
中科院分区：
文献类型：
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作者：
Le-Scherban, Felice;Ballester, Lance;Buehler, James W.
对于保健提供者来说，关于社区一级健康的社会决定因素的信息，如果是针对他们所负责的人口和健康结果的，就最有价值。糖尿病和高血压是高度流行的疾病，其管理需要临床治疗和行为改变的相互作用，这些行为改变可能对社区条件敏感。我们使用了2016年费城联邦合格健康中心网络的非裔美国人患者的地理链接电子健康记录，以检查患者居住社区特征与高血压和糖尿病控制之间的横断面关联（分别为n = 1061和n = 2633）。高血压和糖尿病控制的定义符合卫生资源和服务管理局（HRSA）统一数据系统（UDS）对HRSA资助的卫生中心的报告要求。我们研究了邻里社会经济地位（贫困，教育，剥夺指数），社会环境（暴力犯罪，感知安全和社会资本，种族隔离）和建筑环境（土地使用组合，交叉口密度）的九项措施的关联。在人口统计学调整的对数二项回归模型中，解释了社区水平的聚类，糖尿病和高血压控制不良在高度隔离的社区更常见（即，非裔美国人居民相对于费城平均值的比例较高;糖尿病患病率= 1.27 [1.02-1.57]，高血压患病率= 1.22 [1.12-1.33]），在更适合步行的社区不太常见（即，更高的零售用地）。邻里剥夺也与高血压控制不良弱相关。在使地理信息可操作的供应商的一个重要考虑是了解特定的社区层面的决定因素如何影响病人群体超越个人层面的决定因素。
For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control (n = 1061 and n = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02-1.57] for diabetes, 1.22 [1.12-1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants.