Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis.
Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis.
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地理加权模型探索影响美国县级糖尿病患者心血管死亡率的社会和环境因素：横断面分析。
DOI：
10.1016/j.amjcard.2023.09.084
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Sattar,Naveed
中科院分区：
文献类型：
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作者：
Zelko,Andrea;Salerno,PedroRVO;Al-Kindi,Sadeer;Ho,Fredrick;Rocha,FannyPetermann;Nasir,Khurram;Rajagopalan,Sanjay;Deo,Salil;Sattar,Naveed
2型糖尿病（T2 D）患者的心血管死亡率存在差异。研究表明，这些差异往往与健康的环境和社会决定因素有关。本研究探讨了美国空气污染、健康的社会决定因素和T2 D相关年龄调整心血管死亡率（aa-CVM）之间的空间差异。我们从疾病控制和预防中心WONDER（流行病学研究的广泛在线数据）（2010年至2019年）获得了与aa-CVM相关的县级T2 D（每10万居民）。我们拟合了一个地理加权线性回归，以aa-CVM作为结果，并包括以下协变量（环境空气污染[2.5 µm大小的颗粒物]，家庭年收入中位数，种族/少数民族，高等教育，农村，粮食不安全和初级卫生保健获得）。总体而言，中位aa-CVM率为92.9，南部最高（102.2）。在西方，aa-CVM与2.5 µm大小的颗粒物，家庭年收入中位数，少数民族地位和初级卫生保健的获得显着相关。粮食不安全是中西部和东北部最严重的风险，而在南部，家庭年收入中位数和粮食不安全程度很高。总之，本研究证明了美国T2 D相关aa-CVM决定因素的暴露存在显著的区域差异。这些研究结果应在政策框架和干预措施中加以考虑，作为解决T2 D相关aa-CVM的社区一级方法的一部分，并在更广泛的州和国家关于人口健康重要性的讨论中加以考虑。
Disparities exist in the cardiovascular mortality rates among people with type 2 diabetes (T2D). Research has established that these disparities are often related to the environmental and social determinations of health. This study explores the spatial variation between air pollution, social determinants of health and T2D related age-adjusted cardiovascular mortality (aa-CVM) in the United States. We obtained county-level T2D related to aa-CVM (per 100,000 residents) from Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) (2010 to 2019). We fit a geographically weighted linear regression with aa-CVM as the outcome and the following covariates (ambient air pollution [particulate matter of 2.5 µm size], median annual household income, racial/ethnic minorities, higher education, rurality, food insecurity, and primary health care access) were included. Overall, the median aa-CVM rate was 92.9 and highest in the South (102.2). In the West, aa-CVM was significantly associated with particulate matter of 2.5 µm size, annual median household income, racial minority status and primary health care access. Food insecurity was the most significant exposure in the Midwest and Northeast, while in the South, annual median household income and food insecurity were significant. In conclusion, this study demonstrated a substantial regional variation of exposure to determinants of T2D related aa-CVM in the United States. These findings should be considered in policy frameworks and interventions as part of community-level approaches to addressing T2D related aa-CVM, and within broader state and national discussions of the importance of population health.