Walker Rebekah J, Gebregziabher Mulugeta, Martin-Harris Bonnie, Egede Leonard E
Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC.
Gen Hosp Psychiatry. 2014 Nov-Dec;36(6):662-8. doi: 10.1016/j.genhosppsych.2014.06.011. Epub 2014 Jul 9.
The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life.
Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates.
In final adjusted models, significant associations for HbA1c included education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β = -0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI: -0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI: -0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived stress (β = -0.12, CI: -0.19 to -0.06).
Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.
本研究旨在调查健康的社会经济和心理社会决定因素对糖尿病知识、自我护理、糖尿病结局及生活质量的独立影响。
对来自美国东南部两家成人初级保健诊所的615名成年人进行横断面抽样。主要结局变量为糖尿病知识、自我护理行为（饮食、运动、药物依从性、血糖检测、足部护理）以及糖尿病结局（糖化血红蛋白、低密度脂蛋白、血压、SF-12生活质量量表的躯体健康评分、SF-12生活质量量表的心理健康评分）。协变量包括年龄、性别、种族/民族、婚姻状况、健康素养及合并症。采用线性回归模型评估在控制协变量情况下的独立关联。
在最终调整模型中，与糖化血红蛋白存在显著关联的因素包括教育程度[β = -0.72，95%置信区间（CI）：-1.36至-0.08]、收入（β = -0.66，CI：-1.30至-0.16）、自我效能感（β = -0.12，CI：-0.15至-0.08）和糖尿病困扰（β = 0.43，CI：0.14至0.72）。与自我护理存在显著关联的因素包括药物依从性与糖尿病困扰（β = -0.58，CI：-0.91至-0.25）以及感知压力（β = -0.12，CI：-0.18至-0.05），运动与抑郁（β = -0.06，CI：-0.10至-0.01）以及自我效能感（β = 0.06，CI：0.01至0.10）。与生活质量存在显著关联的因素包括抑郁（β = -0.08，CI：-0.12至-0.03）、严重心理困扰（β = -0.09，CI：-0.12至-0.05）、社会支持（β = 0.01，CI：0.001至0.02）以及感知压力（β = -0.12，CI：-0.19至-0.06）。
健康的社会决定因素与糖尿病自我护理及结局显著相关，社会经济因素最常与糖尿病结局相关，而心理因素，特别是自我效能感和感知压力最常与自我护理及生活质量相关。
