Thomas Leela V, Jurkovitz Claudine T, Zhang Zugui, Fawcett Mitchell R, Lenhard M James
Department of Social Work, Wesley College of Health and Behavioral Sciences, Delaware State University, Dover, Delaware.
Institute for Research in Equity and Community Health (iREACH), ChristianaCare, Wilmington, Delaware.
AJPM Focus. 2024 Feb 3;3(3):100201. doi: 10.1016/j.focus.2024.100201. eCollection 2024 Jun.
Risk of complications due to gestational diabetes mellitus is increasing in the U.S., particularly among individuals from racial minorities. Research has focused largely on clinical interventions to prevent complications, rarely on individuals' residential environments. This retrospective cohort study aims to examine the association between individuals' neighborhoods and complications of gestational diabetes mellitus.
Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median.
Bivariate analysis showed that the average percentage of adults earning <$35,000 was higher in neighborhoods where individuals with complications were living than in neighborhoods where individuals without complications were living (30.40%±12.05 vs 28.94%±11.71, =0.0145). Individuals who lived in areas with ≥8.9% of residents aged >25 years with less than high school diploma had a higher likelihood of complications than those who lived in areas with <8.9% of such residents (33.43% vs 29.02%, =0.0272). Individuals who lived in neighborhoods that had ≥1.8% of households receiving public assistance were more likely to have complications than those who lived in areas where <1.8% of households received public assistance (33.33% vs 28.97%, =0.0287). Logistic regression revealed that the odds of deliveries with complications were 44% higher for individuals with obesity (OR=1.44; 95% CI=1.17, 1.77), 35% greater for individuals residing in neighborhoods with higher percentages of households living below the poverty level (OR=1.35; 95% CI=1.09, 1.66), and 28% lower for individuals from neighborhoods where a higher percentage of households had no vehicles available for transportation to work (OR=0.72; 95% CI=0.59, 0.89).
Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus.
在美国，妊娠糖尿病导致并发症的风险正在增加，尤其是在少数族裔个体中。研究主要集中在预防并发症的临床干预措施上，很少关注个体的居住环境。这项回顾性队列研究旨在探讨个体所在社区与妊娠糖尿病并发症之间的关联。
从电子健康记录中提取人口统计学和临床数据，并与美国人口普查局2014 - 2018年的美国社区调查数据相关联，涉及2047名个体的2164次分娩。在2021 - 2022年使用Wilcoxon秩和检验和卡方检验进行双变量分析，并使用逻辑回归分析独立效应。模型中使用的所有基于普查区的变量均在中位数处进行二分。
双变量分析显示，有并发症个体居住社区中收入低于35000美元的成年人平均百分比高于无并发症个体居住社区（30.40%±12.05对28.94%±11.71，P = 0.0145）。居住在居民年龄大于25岁且高中以下学历居民比例≥8.9%地区的个体发生并发症的可能性高于居住在该比例<8.9%地区的个体（33.43%对29.02%，P = 0.0272）。居住在接受公共援助家庭比例≥1.8%社区的个体比居住在该比例<1.8%地区的个体更易发生并发症（33.33%对28.97%，P = 0.0287）。逻辑回归显示，肥胖个体分娩出现并发症的几率高44%（OR = 1.44；95% CI = 1.17，1.77），居住在贫困家庭比例较高社区的个体高35%（OR = 1.35；95% CI = 1.09，1.66），居住在家庭无车辆用于上班比例较高社区的个体低28%（OR = 0.72；95% CI = 0.59，0.89）。
临床干预与环境改变相结合有助于预防妊娠糖尿病的母婴并发症。
