NEIGHBORHOOD CHARACTERISTICS AND RISK OF GESTATIONAL DIABETES IN NEW YORK CITY

纽约市的社区特征和妊娠糖尿病风险

• 批准号: 7405150
• 负责人: Teresa Janevic
• 金额: $ 3.06万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7405150
• 关键词: NEIGHBORHOOD; CHARACTERISTICS; RISK; GESTATIONAL; DIABETES

DESCRIPTION (provided by applicant): The incidence of gestational diabetes, characterized as glucose intolerance with onset during pregnancy, is increasing. Diet, physical activity, and obesity are modifiable risk factors that have been implicated in gestational diabetes. Concurrently, there has been concern regarding the increase in obesity, motivating interest in identifying environmental determinants of obesity that might impact individual behavior, including features of the neighborhood in which one lives. One neighborhood feature that might impact the risk of obesity and that of gestational diabetes is the availability of healthy foods. Another neighborhood feature is ethnic concentration. South Asian, Latin American, African, and Caribbean women are at an increased risk of gestational diabetes, especially those who are foreign-born. It has been suggested that this increased risk found in immigrant women might in part be due to change in diet and lifestyle upon immigration. Thus, it is likely that for immigrant women, living outside of ethnic enclaves might increase their risk of gestational diabetes by exposing them to greater changes in diet and lifestyle, while experiencing decreased social and instrumental support. Using linked New York City hospital discharge, birth certificate, commercial food, and census data, this study will be the first ever to examine the association between neighborhood characteristics and the risk of gestational diabetes. The following research questions will be addressed using multilevel models controlling for potential individual-level (education, ethnicity, parity, age, Medicaid status) and neighborhood-level (deprivation) confounders: 1) Is a poor neighborhood food environment score, defined as a combination of number of supermarkets, fast food restaurants, fruit and vegetable stands, and natural food stores, associated with higher risk of gestational diabetes?; 2) Does the strength of this association vary according to the mother's education level and employment status?; and 3) What is the association between neighborhood food environment, ethnic concentration and GDM within seven immigrant groups in NYC? Infants of mothers with gestational diabetes are at greater risk of complications at birth including macrosomia and trauma during delivery. They are also at greater risk of obesity, impaired glucose tolerance, and diabetes in childhood and adolescence. Given the increasing incidence of gestational diabetes, along with the ethnic disparity in risk, learning more about contextual risk factors for gestational diabetes is essential for addressing the CDC objectives of promoting healthy pregnancy and birth outcomes and improving risk factors for future disease among infants and toddlers. The proposed study is unique in that it addresses how the neighborhoods in which women live affect their risk of an important complication during pregnancy. Information regarding the associations of neighborhood food environment and ethnic concentration with gestational diabetes can support the design of healthy communities that promote health by encouraging healthy behaviors, quality of life, and social connectedness.

描述（由申请人提供）：妊娠糖尿病的发病率是在怀孕期间发作的葡萄糖不耐症。饮食，体育锻炼和肥胖是妊娠糖尿病中涉及的可改变的危险因素。同时，人们一直担心肥胖的增加，激发人们对可能影响个人行为的肥胖环境决定因素的兴趣，包括一个人居住的社区特征。可能影响肥胖风险和妊娠糖尿病风险的一个社区特征是健康食品的可用性。另一个社区特征是种族集中。南亚，拉丁美洲，非洲和加勒比海妇女患妊娠糖尿病的风险增加，尤其是那些外国出生的妇女。有人提出，移民妇女的这种风险增加可能部分是由于移民时饮食和生活方式的改变。因此，生活在族裔飞地之外的移民妇女中，可能会通过使妊娠糖尿病的风险增加饮食和生活方式的变化，同时经历社交和工具支持下降，从而增加其妊娠糖尿病的风险。使用纽约市医院出院，出生证明，商业食品和人口普查数据，这项研究将是有史以来第一个研究邻里特征与妊娠糖尿病风险之间的关联的研究。以下研究问题将使用多层次模型来解决潜在的个人级别（教育，种族，平价，年龄，医疗补助状况）和邻里水平（剥夺）混杂因素：1）是一个贫困的邻里食品环境得分，定义为多种超市，快餐店，水果餐厅，水果和蔬菜和自然食品商店，与更高风险的糖尿病风险相关的超级市场，快餐店，水果餐厅，水果。 2）该协会的力量会根据母亲的教育水平和就业状况而有所不同吗？ 3）纽约市七个移民群体内的邻里食品环境，种族集中和GDM之间的关联是什么？妊娠糖尿病的母亲的婴儿出生时出现并发症的风险更大，包括分娩期间的大糖尿病和创伤。它们还面临着肥胖，葡萄糖耐受性受损以及儿童和青春期糖尿病的更大风险。鉴于妊娠糖尿病的发生率的增加，以及风险的种族差异，对妊娠糖尿病的上下文危险因素的了解更多对于解决疾病预防控制中的疾病预防控制中心的目标是促进健康怀孕和出生结果的目标，以及改善婴儿和幼儿的未来疾病风险因素。拟议的研究是独一无二的，因为它解决了妇女居住的社区如何影响其怀孕期间重要并发症的风险。有关邻里粮食环境与种族集中与妊娠糖尿病的关联的信息可以通过鼓励健康的行为，生活质量和社会联系来支持促进健康的健康社区的设计。