Zhang Y Tara, Mujahid Mahasin S, Laraia Barbara A, Warton E Margaret, Blanchard Samuel D, Moffet Howard H, Downing Janelle, Karter Andrew J
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California.
Division of Public Health Nutrition, School of Public Health, University of California, Berkeley, Berkeley, California.
Am J Epidemiol. 2017 Jun 15;185(12):1297-1303. doi: 10.1093/aje/kwx017.
We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a geographic information system for each patient's address of longest residence. We estimated the association between change in supermarket presence (gain, loss, or no change) and change in HbA1c value, adjusting for individual- and area-level attributes and according to baseline glycemic control (near normal, <6.5%; good, 6.5%-7.9%; moderate, 8.0%-8.9%; and poor, ≥9.0%). Supermarket loss was associated with worse HbA1c trajectories for those with good, moderate, and poor glycemic control at baseline, while supermarket gain was associated with marginally better HbA1c outcomes only among patients with near normal HbA1c values at baseline. Patients with the poorest baseline HbA1c values (≥9.0%) had the worst associated changes in glycemic control following either supermarket loss or gain. Differences were not clinically meaningful relative to no change in supermarket presence. For patients with type 2 diabetes mellitus, gaining neighborhood supermarket presence did not benefit glycemic control in a substantive way. The significance of supermarket changes on health depends on a complex interaction of resident, neighborhood, and store characteristics.
我们评估了北加利福尼亚凯撒医疗集团糖尿病登记处患者（434,806人年；2007 - 2010年）社区超市增减与血糖控制（通过糖化血红蛋白（HbA1c）值评估）之间的关联。每年的临床测量数据与每个患者居住时间最长地址的地理信息系统指标相关联。我们估计了超市存在的变化（增加、减少或无变化）与HbA1c值变化之间的关联，并根据个体和区域层面的属性以及基线血糖控制情况（接近正常，<6.5%；良好，6.5% - 7.9%；中等，8.0% - 8.9%；差，≥9.0%）进行了调整。对于基线血糖控制良好、中等和较差的患者，超市减少与HbA1c轨迹变差相关，而超市增加仅与基线HbA1c值接近正常的患者中略微更好的HbA1c结果相关。基线HbA1c值最差（≥9.0%）的患者在超市减少或增加后血糖控制的相关变化最差。相对于超市存在无变化而言，这些差异在临床上无显著意义。对于2型糖尿病患者，社区超市增加并未在实质上改善血糖控制。超市变化对健康的影响取决于居民、社区和商店特征的复杂相互作用。
