Department of Statistics, Rice University, Houston, Texas.
Children's Environmental Health Initiative, Rice University, Houston, Texas.
Am J Epidemiol. 2018 Jul 1;187(7):1467-1476. doi: 10.1093/aje/kwy026.
Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007-2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.
邻里特征（如种族隔离）可能与 2 型糖尿病有关，但这些关系尚未使用适用于具有地理模式的健康结果的空间模型进行研究。我们为一个指定区域内的黑人居民构建了一个本地、空间种族隔离（RI）指数，以衡量他们彼此之间的暴露程度，以估计糖尿病与 RI 的关联，并研究 RI 与糖尿病的空间模式的关系。我们从 2007 年至 2011 年从 Duke Medicine Enterprise Data Warehouse 获得了电子健康记录。根据居住的普查块，将患者数据与 RI 联系起来。我们使用非空间和空间贝叶斯模型来评估糖尿病的空间变化及其与 RI 的关系。与仅包含患者年龄和性别的空间模型相比，在包含 RI 的空间模型中，非西班牙裔白人和黑人居民的糖尿病的剩余地理异质性分别降低了 29%和 24%。RI 增加 0.20 个单位与白人（风险比=1.24，95%可信区间：1.17，1.31）和黑人（风险比=1.07，95%可信区间：1.05，1.10）居民的糖尿病风险增加相关。更好地了解与糖尿病相关的邻里特征可以为制定政策干预措施提供信息。
