Evaluation of Natural Experiments of Nutrition Assistance to Prevent and Control Diabetes among Low-Income Communities

低收入社区营养辅助防治糖尿病自然实验评价

• 批准号: 10223873
• 负责人: DEAN SCHILLINGER
• 金额: $ 44.99万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10223873
• 关键词: Evaluation; Natural; Experiments; Nutrition; Assistance

ABSTRACT/PROJECT SUMMARY LIFESPAN-D (LongItudinal Food security Experiments via SuPplemental Assistance with Nutrition for Diabetes), is the first evaluation of large-scale natural experiments to determine the health and cost-related effects of nutrition assistance (SNAP and WIC) on T2D outcomes across the lifespan. Food insecurity (FI) is a common, potent factor in the development of type 2 diabetes mellitus (T2D) among low-income populations in the US, and a contributor to socioeconomic, racial and ethnic disparities. FI pressures people to consume low-cost carbohydrate- and energy-rich foods that increase the risk of T2D and makes its clinical management more challenging; creates chronic stress; presents a “competing demand” that crowds out attempts to engage in other health-promoting behaviors; and forces individuals with T2D to make difficult choices between paying share of costs for medicine, monitoring or healthcare vs. paying for nutritious food or other essential needs—creating a Sophie's Choice that can worsen T2D controls and accelerate complications. FI populations are also predisposed to trans-generational elevated risk for T2D, in part, through in utero metabolic programming. FI has been associated with increased progression from prediabetes to T2D, increased gestational diabetes (GDM), and increased hospitalizations for glycemic events among low-income populations with T2D. FI can be reduced and dietary quality improved through nutrition assistance programs, yet whether such programs can improve T2D-related outcomes among vulnerable populations remains an unanswered question. We address this critical question across the lifespan, studying two natural experiments in nutrition assistance policy to address the question: To what extent, and among which populations, does reducing FI through nutrition assistance affect T2D and gestational diabetes (GDM) rates, T2D control, and T2D complication-related ED visits and hospitalizations? And what are the health economic implications? First, we will evaluate a new California statewide policy that allows individuals who receive SSI - a federal income supplement program to help aged, blind and disabled people of low income – to now be concurrently eligible for the federal Supplemental Nutrition Assistance Program (SNAP). Using a quasi-experimental design and statewide longitudinal datasets, we will measure cardiometabolic control, ED visits and hospitalizations for complications among low-income individuals with T2D, as well as incident T2D among individuals with prediabetes. Second, we will evaluate a new California policy within the federal Nutrition Program for Women, Infants, and Children (WIC) that is shifting WIC from a paper voucher to an Electronic Benefits Transfer (EBT) card system that will increase uptake of WIC benefits. Using a quasi-experimental design and statewide and national datasets, we will measure effects of eWIC on perinatal outcomes, including GDM and gestational weight gain among mothers and birth outcomes of their offspring. Third, we will estimate the cost-effectiveness of the policies (SSI-SNAP and WIC policy), incorporating ED visits, hospitalizations and long-term care costs and projected costs averted related to better cardiometabolic control and lower T2D incidence.

摘要/项目摘要 LIFESPAN-D（通过糖尿病营养补充援助进行的长期粮食安全实验）， 是对大规模自然实验的首次评估，以确定对健康和成本相关的影响 针对 T2D 整个生命周期结局的营养援助（SNAP 和 WIC）。粮食不安全（FI）是一种常见的、 美国低收入人群患 2 型糖尿病 (T2D) 的潜在因素，以及 造成社会经济、种族和民族差异的因素。 FI迫使人们低成本消费 富含碳水化合物和能量的食物会增加 T2D 的风险并使其临床管理更加困难 具有挑战性的;造成慢性压力；提出了“竞争需求”，排挤了参与其他活动的尝试 促进健康的行为；并迫使患有 T2D 的个人在支付份额之间做出艰难的选择 药品、监测或医疗保健费用与支付营养食品或其他基本需求的费用——创造一个 苏菲的选择可能会恶化 T2D 控制并加速并发症。 FI 人群还 易患 T2D 的跨代风险升高，部分原因是通过子宫内代谢编程。 FI 有 与从糖尿病前期发展为 T2D 的进展增加、妊娠期糖尿病 (GDM) 增加有关， 低收入 T2D 人群因血糖事件而住院的人数增加。 FI可以减少 通过营养援助计划改善膳食质量，但这些计划能否改善 弱势群体中与 T2D 相关的结果仍然是一个悬而未决的问题。我们解决这个关键问题 整个生命周期的问题，研究营养援助政策中的两个自然实验，以解决 问题：通过营养援助减少膳食摄入对哪些人群有多大影响？ T2D 和妊娠糖尿病 (GDM) 发生率、T2D 控制情况以及与 T2D 并发症相关的 ED 就诊和 住院治疗？对健康经济有何影响？首先，我们将评估一个新的加州 全州范围内的政策，允许接受 SSI 的个人——一项联邦收入补充计划，旨在帮助老年人、 低收入盲人和残疾人 – 现在同时有资格享受联邦补充补助 营养援助计划（SNAP）。使用准实验设计和全州纵向数据集， 我们将衡量低收入人群的心脏代谢控制、急诊就诊和并发症住院情况 T2D 患者以及糖尿病前期患者中发生的 T2D 患者。其次，我们将评估 联邦妇女、婴儿和儿童营养计划 (WIC) 中的加州新政策正在发生变化 WIC 从纸质凭证到电子福利转账 (EBT) 卡系统，这将提高 WIC 的使用率 好处。使用准实验设计以及全州和国家数据集，我们将衡量以下因素的影响 eWIC 关于围产期结局，包括 GDM 和母亲妊娠期体重增加以及婴儿的出生结局 他们的后代。第三，我们将评估政策（SSI-SNAP 和 WIC 政策）的成本效益， 纳入急诊就诊、住院和长期护理费用以及与改善相关的预计可避免的费用 心脏代谢控制和降低 T2D 发病率。