邻里社会失序与糖尿病结局如何相关？一项关于血糖控制和自我报告的急性或紧急医疗服务使用情况的多层次调查。
How is neighborhood social disorganization associated with diabetes outcomes? A multilevel investigation of glycemic control and self-reported use of acute or emergency health care services.
作者信息
Kowitt Sarah D, Donahue Katrina E, Fisher Edwin B, Mitchell Madeline, Young Laura A
机构信息
1Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 USA.
2Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.
出版信息
Clin Diabetes Endocrinol. 2018 Oct 19;4:19. doi: 10.1186/s40842-018-0069-0. eCollection 2018.
BACKGROUND
Diabetes management is influenced by a number of factors beyond the individual-level. This study examined how neighborhood social disorganization (i.e., neighborhoods characterized by high economic disadvantage, residential instability, and ethnic heterogeneity), is associated with diabetes-related outcomes.
METHODS
We used a multilevel modeling approach to investigate the associations between census-tract neighborhood social disorganization, A1c, and self-reported use of acute or emergency health care services for a sample of 424 adults with type 2 diabetes.
RESULTS
Individuals living in neighborhoods with high social disorganization had higher A1c values than individuals living in neighborhoods with medium social disorganization (B = 0.39, = 0.01). Individuals living in neighborhoods with high economic disadvantage had higher self-reported use of acute or emergency health care services than individuals living in neighborhoods with medium economic disadvantage (B = 0.60, = 0.02).
CONCLUSIONS
High neighborhood social disorganization was associated with higher A1c values and high neighborhood economic disadvantage was associated with greater self-reported use of acute or emergency health care services. Controlling for individual level variables diminished this effect for A1c, but not acute or emergency health care use. Comprehensive approaches to diabetes management should include attention to neighborhood context. Failure to do so may help explain the continuing disproportionate diabetes burden in many neighborhoods despite decades of attention to individual-level clinical care and education.
TRIAL REGISTRATION
For this study, we used baseline data from a larger study investigating the impacts on patient-centered outcomes of three different approaches to self-monitoring of blood glucose among 450 adults with non-insulin dependent type 2 diabetes living in North Carolina. This study was registered as a clinical trial on 1/7/2014 (https://clinicaltrials.gov/ct2/show/NCT02033499).
背景
糖尿病管理受到个体层面以外的多种因素影响。本研究探讨邻里社会失序（即具有高经济劣势、居住不稳定和种族异质性特征的社区）如何与糖尿病相关结局相关联。
方法
我们采用多层次建模方法，对424名2型糖尿病成年患者样本，研究普查区邻里社会失序、糖化血红蛋白（A1c）以及自我报告的急性或紧急医疗保健服务使用情况之间的关联。
结果
生活在社会失序程度高的社区的个体，其A1c值高于生活在社会失序程度中等社区的个体（B = 0.39，P = 0.01）。生活在经济劣势高的社区的个体，自我报告的急性或紧急医疗保健服务使用频率高于生活在经济劣势中等社区的个体（B = 0.60，P = 0.02）。
结论
邻里社会失序程度高与更高的A1c值相关，邻里经济劣势高与自我报告的急性或紧急医疗保健服务使用频率更高相关。控制个体层面变量可减弱对A1c的这种影响，但对急性或紧急医疗保健服务使用情况则不然。糖尿病管理的综合方法应包括关注邻里环境。未能做到这一点可能有助于解释，尽管数十年来一直关注个体层面的临床护理和教育，但许多社区的糖尿病负担仍持续存在且不成比例。
试验注册
对于本研究，我们使用了一项更大规模研究的基线数据，该研究调查了北卡罗来纳州450名非胰岛素依赖型2型糖尿病成年患者中三种不同血糖自我监测方法对以患者为中心的结局的影响。本研究于2014年1月7日注册为一项临床试验（https://clinicaltrials.gov/ct2/show/NCT02033499）。
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