Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI.
Diabetes Care. 2024 Jun 1;47(6):964-969. doi: 10.2337/dc23-2184.
We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample.
Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract-level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners' Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population.
Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = -0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = -0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = -0.17; P < 0.001), unemployment (r = -0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population.
Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.
我们在美国全国样本中调查了历史上的红线划分与糖尿病患病率之间的直接和间接关系。
我们使用了一个经过验证的概念模型，假设结构种族主义与糖尿病患病率之间存在通过歧视、监禁、贫困、物质使用、住房、教育、失业和食物获取等途径。我们将普查区数据与糖尿病患病率相结合，这些数据来自疾病控制与预防中心的 PLACES 2019 数据库，使用 Mapping Inequality 项目中的历史房主贷款公司（HOLC）地图来表示红线划分，以及来自 Opportunity Insights 数据库的普查数据。每个普查区的 HOLC 等级（介于 1（最佳）到 4（红线）之间的分数）是基于与历史上 HOLC 评级区域的重叠情况。最终分析样本包括 11375 个美国普查区。结构方程模型用于在调整 2010 年人口后，调查直接和间接关系。
在调整 2010 年人口后，红线划分与普查区内糖尿病的粗患病率直接相关（r = 0.01；P = 0.008）（χ2（54）= 69900.95；P < 0.001；均方根误差逼近 = 0；比较拟合指数 = 1）。红线划分通过监禁（r = 0.06；P < 0.001）、贫困（r = -0.10；P < 0.001）、歧视（r = 0.14；P < 0.001）、物质使用（通过 binge drinking 衡量：r = -0.65，P < 0.001；和吸烟：r = 0.35，P < 0.001）、住房（r = 0.06；P < 0.001）、教育（r = -0.17；P < 0.001）、失业（r = -0.17；P < 0.001）和食物获取（r = 0.14；P < 0.001）与糖尿病患病率间接相关，这些因素在调整 2010 年人口后得到了调整。
红线划分与糖尿病患病率之间存在显著的直接和间接关系。监禁、贫困、歧视、物质使用、住房、教育、失业和食物获取可能是旨在减轻结构种族主义对糖尿病影响的干预措施的可能目标。
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