Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina
Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina
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DOI：
10.1093/aje/kwy026
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发表时间：
2018-07-01
影响因子：
5
通讯作者：
Miranda, Marie Lynn
中科院分区：
文献类型：
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作者：
Bravo, Mercedes A.;Anthopolos, Rebecca;Miranda, Marie Lynn
种族隔离等社区特征可能与2型糖尿病有关，但研究尚未使用适合地理模式健康结果的空间模型来检验这些关系。我们为特定区域的黑人居民构建了一个当地的种族隔离空间指数（RI），测量他们只与彼此接触的程度，以估计糖尿病与RI的关联，并研究RI如何与糖尿病的空间模式相关。我们从杜克医药企业数据仓库获得2007-2011年的电子健康记录。患者数据与基于居住人口普查街区的RI相关联。我们使用空间和空间贝叶斯模型来评估糖尿病的空间变异及其与RI的关系。与考虑患者年龄和性别的空间模型相比，纳入RI的空间模型中糖尿病的剩余地理异质性在非西班牙裔白人和黑人居民中分别降低了29%和24%。每增加0.20个单位的RI与白人（风险比= 1.24,95%可信区间：1.17,1.31）和黑人（风险比= 1.07,95%可信区间：1.05,1.10）居民患糖尿病的风险增加相关。更好地了解与糖尿病相关的社区特征可以为政策干预的制定提供信息。
Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007-2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.