Are Diabetes Risk and Preventive Behaviors Shared in Households?

描述（由申请人提供）：糖尿病是一种复杂的、多因素的疾病，在美国影响着2600万人，另外还有7900万人处于患糖尿病的高危状态。然而，90%的糖尿病高危人群不知道他们的风险，很少有人得到医疗保健提供者关于改善饮食、体育活动和减轻体重以降低患糖尿病风险的指导。我们也很少知道这些行为选择在多大程度上受到一个人的社会关系的影响，特别是住在同一个家庭、共享资源、拥有相同价值观和获得相似信息的伴侣或配偶。例如，癌症或糖尿病等疾病的出现会增加家庭成员对疾病发展的担忧，并刺激他们采取预防措施。本研究旨在通过分析2005年至2014年来自大量不同参保人群的纵向数据，调查这些社会“溢出”效应对家庭内预防行为和糖尿病风险的影响。Kaiser Permanente北加州拥有一个纵向和多种族的数据库，拥有330万会员，并提供了丰富的机会将生物识别、实验室和卫生服务的利用联系起来

DESCRIPTION (provided by applicant): Diabetes is a complex, multi-factorial condition, affecting 26 million people in the United States and an additional 79 million people are at high-risk of developing diabetes. However, 90% of people at high-risk of diabetes don't know about their risk and very few are given guidance by their health care providers about improving their diets, physical activity, and lowering weight to reduce their risk of getting diabetes. We also know very little about how much these behavior choices are influenced by one's social connections, particularly partners or spouses that live in the same household, share resources, and have the same values and access to similar information. For example, emergence of diseases like cancers or diabetes can heighten family members' concerns of also developing disease, and stimulate them to engage in preventive behaviors. We aim to investigate these social "spillover" effects on preventive behaviors and diabetes risk within households by analyzing longitudinal data from 2005 to 2014 from a large, diverse insured population. Kaiser Permanente Northern California has a longitudinal and multi-ethnic database of 3.3 million members and offers a rich opportunity to link biometric, laboratory, and health service utilization data for primary plan members and their linked dependents. We will study whether a new diabetes diagnosis in the household prompts partners or spouses to change their lifestyle behaviors; whether this adoption of preventive behaviors is different across demographic or socioeconomic groups; and whether these behaviors are maintained 3-6 years after the diagnosis. We will also study whether adult family members that are on the same health insurance plan and live in the same household of someone that was newly diagnosed with diabetes in this time have a high risk of getting diabetes themselves. And lastly, whether the lifestyle behavior changes adopted are associated with reduced risk of diabetes in the family member? The findings from this study may lead to new ways of identifying people at high risk of diabetes - for example, doctors notifying people with new diabetes diagnoses to encourage their household members to get checked too. In addition, it may also lead to new studies to help whole families change and maintain their lifestyle behaviors together. Our proposal aims to use a unique and underutilized set of databases to answer these topical and innovative questions. Utilizing the combined and interdisciplinary expertise of our Emory University and KPNC study team, we will use advanced statistical and quasi-experimental methods to analyze the data, controlling for measurable biases and using sensitivity analyses to explore factors that cannot be accounted for. This study is novel in concept, efficient in design, and findings will have important implications for screening recommendations, for advising people with a new diagnosis of diabetes, and for exploring avenues to stimulate sustainable healthful behaviors through families.