The role of neighborhood characteristics in racial/ethnic disparities in type 2 diabetes: results from the Boston Area Community Health (BACH) Survey.
The role of neighborhood characteristics in racial/ethnic disparities in type 2 diabetes: results from the Boston Area Community Health (BACH) Survey.
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DOI：
10.1016/j.socscimed.2015.01.041
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
McKinlay JB
中科院分区：
文献类型：
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作者：
Piccolo RS;Duncan DT;Pearce N;McKinlay JB
2型糖尿病(T2 DM)患病率的种族/民族差异是有充分记录的，直到最近，研究几乎完全集中在基于个人的决定因素上，作为这些差异的潜在贡献者(健康行为、生物/遗传因素和个人水平的社会人口统计学)。关于邻里特征在2型糖尿病种族/民族差异中的作用的研究非常有限。因此，本研究的目的是确定和评估社区中可能与T2 DM种族/民族差异相关的特定方面的贡献。这项研究使用了波士顿地区社区健康III调查(N=2,764)的数据，这是一项基于社区的随机抽样调查，调查对象是马萨诸塞州波士顿的三个种族/民族(黑人、西班牙裔和白人)的成年人。我们应用两水平随机截距Logistic回归来评估种族/民族、邻里特征(人口普查地区的社会经济状况、种族构成、财产和暴力犯罪、空地、地理上靠近杂货店、便利店和快餐店、以及邻里无序)与T2 DM患病率(空腹血糖和GT；125 mg/dL、HbA1c≥6.5%或自我报告T2 DM)之间的关系。黑人和西班牙裔参与者患T2 DM的几率分别是白人参与者的2.89倍和1.48倍。多水平模型显示，邻域间的显著方差估计为0.943，提供了邻域变异的证据。个体人口学特征(种族/民族、年龄和性别)解释了T2 DM邻里变异的22.3%。在模型中加入邻里层面的变量对种族/民族差异的大小和邻里之间的变异性影响很小。例如，人口普查地区的贫困在黑人和西班牙裔中解释了不到1%和6%的T2 DM超额赔率，在T2 DM中只解释了1.8%的邻里差异。虽然这项研究的结果总体上表明，邻里因素并不是造成T2 DM种族/民族差异的主要因素，但还需要进一步的研究，包括来自其他地理位置的数据。
Racial/ethnic disparities in the prevalence of type 2 diabetes mellitus (T2DM) are well documented and until recently, research has focused almost exclusively on individual-based determinants as potential contributors to these disparities (health behaviors, biological/genetic factors, and individual-level sociodemographics). Research on the role of neighborhood characteristics in relation to racial/ethnic disparities in T2DM is very limited. Therefore, the aim of this research is to identify and estimate the contribution of specific aspects of neighborhoods that may be associated with racial/ethnic disparities in T2DM. Data from the Boston Area Community Health III Survey (N = 2,764) was used in this study, which is a community-based random-sample survey of adults in Boston, Massachusetts from three racial/ethnic groups (Black, Hispanic, and White). We applied two-level random intercepts logistic regression to assess the associations between race/ethnicity, neighborhood characteristics (census tract socioeconomic status, racial composition, property and violent crime, open space, geographic proximity to grocery stores, convenience stores, and fast food, and neighborhood disorder) and prevalent T2DM (fasting glucose > 125 mg/dL, HbA1c ≥ 6.5%, or self-report of a T2DM diagnosis). Black and Hispanic participants had 2.89 times and 1.48 times the odds of T2DM as White participants, respectively. Multilevel models indicated a significant between-neighborhood variance estimate of 0.943, providing evidence of neighborhood variation. Individual demographics (race/ethnicity, age and gender) explained 22.3% of the neighborhood variability in T2DM. The addition of neighborhood-level variables to the model had very little effect on the magnitude of the racial/ethnic disparities and on the between-neighborhood variability. For example, census tract poverty explained less than 1% and 6% of the excess odds of T2DM among Blacks and Hispanics and only 1.8% of the neighborhood variance in T2DM. While the findings of this study overall suggest that neighborhood factors are not a major contributor to racial/ethnic disparities in T2DM, further research is needed including data from other geographic locations.