The Role of Structural Racism on Disparities in Clinical Outcomes for Diabetes: A Mixed Methods Study

据估计，大约有3710万18岁或以上的成年人(占美国成年人总数的14.7%)患有糖尿病， 其中90%-95%的病例被归类为2型糖尿病(T2 DM)。来自少数族裔的成年人 更高的发病率和死亡率以及较差的结果继续对群体造成不成比例的影响 与非西班牙裔白人成年人相比。人口群体之间存在这些差距的原因仍然存在 难以捉摸；然而，结构性种族主义，定义为法律、政策、体制做法和根深蒂固的 通过相辅相成的不公平制度助长歧视的根植于社会中的规范，已经 被认为是健康结果不平等的根本原因，包括与糖尿病有关的结果。一种表格 结构性种族主义，历史性的红线，即基于以下原因拒绝向社区提供资源的做法 种族，在很大程度上影响着由种族和少数民族群体居住的社区，在那里 糖尿病非常普遍。它已经导致了高度隔离和 由于社区投资不足而导致的资源不足的社区。尽管据报道被禁止了几十年 以前，历史红线和当代糖尿病结果之间的关系并不好- 学习。由于目前的证据支持红线与人口健康之间的联系，这 是一个需要解决的重大差距，以减少糖尿病差异。初步数据来自 我们的小组显示，人们报告说，目前的研究没有考虑他们的生活经历或 适应他们应对的结构性不平等，这限制了他们的自我管理能力 糖尿病。因此，我们建议以历史性的形式评估结构性种族主义的作用。 红线，关于糖尿病的差异及其对当前临床和行为结果的影响， 2000例成年2型糖尿病患者的生活质量和邻里环境。这项研究提供了一种独特的 通过使用试验性融合混合解决方案弥合领域内知识差距的机会 方法研究设计以了解历史红线与糖尿病相关的关系 成年2型糖尿病患者的预后。目标1将使用定性研究方法来探索信念和态度 关于历史红线及其对糖尿病自我管理和预后的影响。目标2将使用量化 确定历史红线对糖尿病影响的直接和间接途径的研究方法- 相关结果(血糖控制、血压控制、血脂控制、自我护理行为(饮食、身体状况 活动，服药依从性，血糖监测)，和生活质量)的成年T2 DM和 调查婚姻关系中的种族/民族和性别/性别的不变性。AIM 3将使用分层建模 评估个人、人际和邻里层面因素对个人层面糖尿病的影响 结果；评估历史红线暴露对著名社区水平的贡献 评估个别级别的关联是否受到历史性红线暴露的影响。

Approximately 37.1 million adults 18 years or older (14.7% of all U.S. adults) are estimated to have diabetes, where 90-95% of cases are classified as type 2 diabetes mellitus (T2DM). Adults from racial/ethnic minority groups continue to be disproportionately impacted by higher morbidity and mortality and poor outcomes compared to Non-Hispanic White adults. The reasons for these disparities among population groups remain elusive; however, structural racism, defined as the laws, policies, institutional practices, and entrenched norms embedded within society that foster discrimination through mutually reinforcing inequitable systems, has been indicated as a root cause of inequities in health outcomes including those related to diabetes. One form of structural racism, historic redlining, known as the practice of denying resources to communities based on race, largely impacts neighborhoods populated by persons from racial and ethnic minority groups where diabetes is highly prevalent. It has led to social and economic disadvantage within hyper-segregated and under-resourced neighborhoods due to community disinvestment. Despite reportedly being banned decades ago, the relationship between historic redlining and contemporary diabetes outcomes has not been well- studied. Since current evidence supports an association between redlining and population health, this is a significant gap that needs to be addressed to reduce diabetes disparities. Preliminary data from our group shows people report that current studies do not account for their lived experiences or accommodate for the structural inequities they deal with that limits their ability to self-manage diabetes. Therefore, we propose to assess the role of structural racism, in the form of historic redlining, on diabetes disparities and how it impacts current-day clinical and behavioral outcomes, quality of life, and the neighborhood environment in 2,000 adults with T2DM. This study offers a unique opportunity to bridge a gap in knowledge within the field by using an experimental convergent mixed methods study design to understand the relationship between historic redlining and diabetes-related outcomes in adults with T2DM. Aim 1 will use qualitative research methods to explore beliefs and attitudes about historic redlining and its impact on diabetes self-management and outcomes. Aim 2 will use quantitative research methods to identify direct and indirect pathways through which historic redlining impacts diabetes- related outcomes (glycemic control, blood pressure control, lipid control, self-care behaviors (diet, physical activity, medication adherence, blood glucose monitoring), and quality of life) in adults with T2DM and investigate invariance by race/ethnicity and sex/gender in the relationship. Aim 3 will use hierarchical modeling to assess the impact of individual, interpersonal, and neighborhood level factors on individual level diabetes outcomes; to assess the contribution of historic redlining exposure toward noted neighborhood level associations; and to assess whether individual level associations are moderated by historic redlining exposure.