Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
Department of Health Sciences, Graduate Program in Public Health, Lehman College, CUNY, 250 Bedford Park Boulevard West Bronx, NY 10468, USA.
Soc Sci Med. 2014 Nov;120:180-9. doi: 10.1016/j.socscimed.2014.09.026. Epub 2014 Sep 16.
Previous research has shown that immigrants living in their own ethnic enclave are at decreased risk of poor health outcomes, but this question has not been studied in relation to gestational diabetes, an important early marker of lifecourse cardiovascular health. We ascertained gestational diabetes, census tract of residence, and individual-level covariates for Sub-Saharan African, Chinese, South Central Asian, Non-Hispanic Caribbean, Dominican, Puerto Rican, Mexican, and Central and South American migrant women using linked birth-hospital discharge data for 89,703 singleton live births in New York City for the years 2001-2002. Using 2000 census data, for each immigrant group we defined a given census tract as part of an ethnic enclave based on the population distribution for the corresponding ethnic group. We estimated odds ratios for associations between living in an ethnic enclave and risk of gestational diabetes adjusted for neighborhood deprivation, percent commercial space, education, age, parity, and insurance status, using multilevel logistic regression. Overall, we found no effect of ethnic enclave residence on gestational diabetes in most immigrant groups. Among South Central Asian and Mexican women, living in a residential ethnic enclave was associated with an increased odds of gestational diabetes. Several explanations are proposed for these findings. Mechanisms explaining an increased risk of gestational diabetes in South Central Asian and Mexican ethnic enclaves should be examined.
先前的研究表明，生活在自身族裔飞地中的移民患健康状况不佳的风险较低，但尚未针对妊娠糖尿病这一重要的生命早期心血管健康指标进行研究。我们利用纽约市 2001-2002 年的 89703 例单胎活产的出生-住院关联数据，确定了撒哈拉以南非洲、中国、中南部亚洲、非西班牙裔加勒比、多米尼加、波多黎各、墨西哥以及中南部美洲移民女性的妊娠糖尿病、居住的普查地段以及个体水平协变量。利用 2000 年普查数据，我们为每个移民群体确定了一个普查地段为族裔飞地，其依据是相应族裔群体的人口分布。我们使用多层次逻辑回归，根据邻里贫困程度、商业空间比例、教育程度、年龄、产次和保险状况，调整了居住在族裔飞地与妊娠糖尿病风险之间关联的比值比。总体而言，我们在大多数移民群体中并未发现居住在族裔飞地对妊娠糖尿病有影响。在中南部亚洲和墨西哥女性中，居住在族裔飞地与妊娠糖尿病的发病几率增加有关。对这些发现提出了几种解释。应该检查中南部亚洲和墨西哥族裔飞地中妊娠糖尿病风险增加的机制。
