Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
BMJ Open. 2022 Oct 25;12(10):e060263. doi: 10.1136/bmjopen-2021-060263.
Understanding the pathway by which neighbourhood factors influence glycaemic control may be crucial to addressing health disparities in diabetes. This study aimed to examine if the pathway between neighbourhood factors and glycaemic control is mediated by stress.
Structured equation modelling (SEM) was used to investigate direct and indirect effects in the relationship between neighbourhood factors, stress and glycaemic control, with standardised estimates to allow comparison of paths.
Data was obtained from 615 adults with type 2 diabetes in the Southeastern United States.
The primary outcome variable was glycaemic control determined by glycated haemoglobin (HbA1c) within the prior 6 months. Neighbourhood factors included neighbourhood violence, aesthetic quality of the neighbourhood, access to healthy food, and social cohesion. Stress was measured using the perceived stress scale.
In the final model (χ(158)=406.97, p<0.001, root mean square error of approximation=0.05, p-close 0.38, Comparative Fit Index=0.97, Tucker-Lewis index=0.96, the coefficient of determination=1.0), violence (r=0.79, p=0.006), neighbourhood aesthetics (r=0.74, p=0.02) and social cohesion (r=0.57, p=0.04) were significantly associated with higher perceived stress. Stress (r=0.06, p=0.004) was directly associated with higher glycaemic control. Significant indirect effects existed between violence and higher HbA1c (r=0.05, p=0.04). After controlling for other neighbourhood factors, there was no significant relationship between access to healthy food and either stress or glycaemic control.
While a number of neighbourhood factors were directly associated with stress, only neighbourhood violence had a significant indirect effect on glycaemic control via stress within the tested pathway. Future studies should examine individual-level stress management interventions and should consider community-level interventions targeting neighbourhood violence as strategies for addressing disparities in diabetes.
了解邻里因素影响血糖控制的途径可能对解决糖尿病健康差异至关重要。本研究旨在检验邻里因素与血糖控制之间的关系是否通过压力起作用。
结构方程模型（SEM）用于研究邻里因素、压力和血糖控制之间关系的直接和间接影响，并采用标准化估计值来比较路径。
数据来自美国东南部的 615 名 2 型糖尿病患者。
主要结果变量是过去 6 个月内糖化血红蛋白（HbA1c）确定的血糖控制情况。邻里因素包括邻里暴力、邻里美观、获得健康食品的机会和社会凝聚力。压力使用感知压力量表测量。
在最终模型中（χ(158)=406.97，p<0.001，近似均方根误差=0.05，p-close=0.38，比较拟合指数=0.97，Tucker-Lewis 指数=0.96，决定系数=1.0），暴力（r=0.79，p=0.006）、邻里美观（r=0.74，p=0.02）和社会凝聚力（r=0.57，p=0.04）与更高的感知压力显著相关。压力（r=0.06，p=0.004）与更高的血糖控制直接相关。暴力与更高的 HbA1c 之间存在显著的间接影响（r=0.05，p=0.04）。在控制其他邻里因素后，获得健康食品与压力或血糖控制之间没有显著关系。
虽然许多邻里因素与压力直接相关，但只有邻里暴力通过压力对血糖控制有显著的间接影响，这在测试的途径中。未来的研究应检验个体层面的压力管理干预措施，并应考虑针对邻里暴力的社区层面干预措施，作为解决糖尿病差异的策略。
