Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Economic Geography, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
Eur J Public Health. 2020 Feb 1;30(1):189-194. doi: 10.1093/eurpub/ckz085.
Body mass index (BMI) is a key covariate in the study of type 2 diabetes, but can also be theorized as a contextual effect. The purpose of this study was to explore the extent to which variation in individual risk factors and neighbourhood BMI explain the variation in type 2 diabetes prevalence across neighbourhoods and municipalities.
Cross-sectional data were collected from 137 820 adults aged ≥18 years from 3296 neighbourhoods in 296 municipalities in the Northern Netherlands. The odds of type 2 diabetes was assessed using a multilevel model. Median odds ratios were calculated and choropleth maps were created to visually assess neighbourhood variation in type 2 diabetes prevalence.
The overall prevalence of type 2 diabetes was 4%, ranging from 0 to ≥10 and 0-7% across neighbourhoods and municipalities, respectively. Of the regional variation, 67.0 and 71.6% is explained through variation of individual risk factors at the neighbourhood and municipality level, respectively. Analysis on the smallest spatial scale, i.e. the neighbourhood, best captured the regional variance. Statistically significant interaction between individual and neighbourhood BMI was found (OR = 1.06; 95% CI = 1.03-1.08, P for interaction < 0.001), adjusted for the individual risk profile.
The results suggest a more cautious interpretation of neighbourhood effects in type 2 diabetes is warranted, and reveals the need for further investigation into risk-prone groups to guide the design of community-level interventions to halt the rise in type 2 diabetes prevalence.
体重指数（BMI）是 2 型糖尿病研究中的一个关键协变量，但也可以被理论化为一种情境效应。本研究旨在探讨个体风险因素和社区 BMI 的变化在多大程度上解释了 2 型糖尿病在社区和城市之间的流行率差异。
从荷兰北部 296 个城市的 3296 个社区中，收集了 137820 名年龄≥18 岁的成年人的横断面数据。使用多水平模型评估 2 型糖尿病的发病几率。计算了中位数优势比，并绘制了专题地图，以直观评估 2 型糖尿病流行率在社区之间的差异。
2 型糖尿病的总体患病率为 4%，范围从 0 到≥10%，社区和城市的患病率分别为 0-7%。在区域差异中，67.0%和 71.6%分别通过社区和城市层面个体风险因素的变化来解释。在最小的空间尺度上，即社区，对区域方差的捕捉效果最好。个体和社区 BMI 之间存在统计学显著的交互作用（OR=1.06；95%CI=1.03-1.08，P 交互<0.001），调整了个体风险状况。
结果表明，需要更谨慎地解释 2 型糖尿病的社区效应，并揭示了需要进一步研究风险易感群体，以指导社区层面干预措施的设计，以遏制 2 型糖尿病流行率的上升。
