Lê-Scherban Félice, Ballester Lance, Castro Juan C, Cohen Suzanne, Melly Steven, Moore Kari, Buehler James W
Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
Prev Med Rep. 2019 Jul 13;15:100953. doi: 10.1016/j.pmedr.2019.100953. eCollection 2019 Sep.
For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control ( = 1061 and = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02-1.57] for diabetes, 1.22 [1.12-1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants.
对于医疗服务提供者而言，有关社区层面健康社会决定因素的信息，若针对他们所负责的人群及健康结果具有特异性时，才最具价值。糖尿病和高血压是高度流行的疾病，其管理需要临床治疗与行为改变相互配合，而行为改变可能对社区状况敏感。我们使用了宾夕法尼亚州费城一个联邦合格健康中心网络中2016年非裔美国患者的地理关联电子健康记录，以检验患者居住社区特征与高血压及糖尿病控制情况（分别为 = 1061和 = 2633）之间的横断面关联。高血压和糖尿病控制的定义符合卫生资源与服务管理局（HRSA）统一数据系统（UDS）对HRSA资助的健康中心的报告要求。我们考察了与邻里社会经济地位的九项指标（贫困、教育、剥夺指数）、社会环境（暴力犯罪、感知安全和社会资本、种族隔离）以及建成环境（土地利用混合、交叉路口密度）的关联。在考虑邻里层面聚类的人口统计学调整对数二项回归模型中，糖尿病和高血压控制不佳在高度隔离的社区更为常见（即非裔美国居民比例相对于费城平均水平较高；糖尿病的患病率比值 = 1.27 [1.02 - 1.57]，高血压为1.22 [1.12 - 1.33]），而在步行性更强的社区（即零售土地利用更高）则较少见。邻里剥夺也与高血压控制不佳存在微弱关联。使地理信息对提供者具有可操作性的一个重要考虑因素是，了解特定的社区层面决定因素如何在个体层面决定因素之外影响患者群体。
