Diabetes control is associated with environmental quality in the USA.
Diabetes control is associated with environmental quality in the USA.
复制标题
DOI：
10.1530/ec-21-0132
复制
发表时间：
2021-08-25
影响因子：
2.9
通讯作者：
Sargis RM
中科院分区：
文献类型：
--
作者：
Jagai JS;Krajewski AK;Price KN;Lobdell DT;Sargis RM
环境参数，包括建筑和社会人口环境，可以影响糖尿病控制（DC）。流行病学研究已将特定的环境因素与DC相关联;然而，尚未评估多维环境状况的影响。环境质量指数（EQI）是一个涵盖五个环境领域的综合定量指标，被视为一种暴露。将美国每个县的DC患病率的经统计学调整的比率用作结果。DC定义为20岁以上、既往诊断为糖尿病、目前没有空腹血糖升高（≥126 mg/dL）或HbA 1c升高（≥6.5）的成人比例。我们对2004-2012年的DC患病率进行了县级分析，并与2006-2010年的EQI和特定领域的指数进行了相关分析，使用随机截距多水平线性回归模型按州进行聚类，并控制了县级肥胖率和身体活动不足率。分析按城乡分层，结果报告为患病率差异（PRD），95% CI比较最高五分位数/最差环境质量与最低五分位数/最佳环境质量。所有县的DC与累积环境质量的相关性在控制后均为阴性（PRD −0.32，95%CI：−0.38，−0.27）;这表明DC率随着环境质量的下降而恶化。虽然整体环境质量对DC的影响在城乡范围内各不相同，但不良的社会人口和建筑环境因素与全国DC减少有关。这些数据表明，通过更大规模的政策和实践干预措施来改善环境质量，可能会改善血糖控制，降低高血糖症引起的发病率和死亡率。
Environmental parameters, including built and sociodemographic environments, can impact diabetes control (DC). Epidemiological studies have associated specific environmental factors with DC; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI), a comprehensive quantitative metric capturing five environmental domains, was considered as an exposure. Age-adjusted rates of DC prevalence for each county in the United States were used as an outcome. DC was defined as the proportion of adults aged 20+ years with a previous diabetes diagnosis who currently do not have high fasting blood glucose (≥126 mg/dL) or elevated HbA1c (≥6.5). We conducted county-level analyses of DC prevalence rates for the years 2004–2012 in association with EQI for 2006–2010 and domain-specific indices using random intercept multilevel linear regression models clustered by state and controlled for county-level rates of obesity and physical inactivity. Analyses were stratified by rural–urban strata, and results are reported as prevalence rate differences (PRD) with 95% CIs comparing highest quintile/worst environmental quality to lowest quintile/best environmental quality. The association of DC with cumulative environmental quality was negative after control for all counties (PRD −0.32, 95% CI: −0.38, −0.27); suggesting that rates of DC worsen as environmental quality declines. While overall environmental quality exerts effects on DC that vary across the rural–urban spectrum, poor sociodemographic, and built environmental factors are associated with decreased DC nationally. These data suggest improvements in environmental quality mediated by larger-scale policy and practice interventions may improve glycemic control and reduce the morbidity and mortality arising from hyperglycemia.