Sy Mamadou, Pilla Scott, Bennett Wendy, Yeh Hsin-Chieh, Baptiste-Roberts Kesha, Gary-Webb Tiffany L, Vaidya Dhananjay, Clark Jeanne M
Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA.
Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
J Gen Intern Med. 2025 Jun;40(8):1728-1734. doi: 10.1007/s11606-024-09232-5. Epub 2025 Jan 2.
To assess the influence of neighborhood socioeconomic deprivation on the effectiveness of an intensive lifestyle intervention (ILI) in the Look AHEAD trial.
Look AHEAD randomized adults with overweight/obesity and type 2 diabetes to ILI for weight loss, or Diabetes Support and Education (DSE). We linked participant data from four study sites to the 2000 United States Census to generate a neighborhood socioeconomic deprivation score. We analyzed the effect of neighborhood deprivation in tertiles on various clinical outcomes including weight and HbA1c changes over 4 years using a mixed-effects linear model with random intercept and an interaction term between deprivation tertile and study arm over 4 years.
Among 1213 participants at baseline, the mean age was 60 years, 41% were male, and 65% identified as White, 26% as Black, and 4% as Hispanic. Most participants had a college degree (84%) and reported an annual income over $40,000 (75%). The deprivation score ranged from -12.04 to -2.61 in the most deprived tertile and 2.01 to 18.69 in the least deprived tertile (the lower the score, the higher the deprivation). There were no statistically significant treatment differences by deprivation score in weight or HbA1c changes over the 4-year period.
In this clinical trial population, an intensive lifestyle intervention was equally effective across levels of neighborhood socioeconomic deprivation. However, these findings may not extend to individuals with the lowest income and educational attainment who are not typically represented in clinical trials and for whom more research is needed.
在“展望未来”（Look AHEAD）试验中评估社区社会经济剥夺对强化生活方式干预（ILI）效果的影响。
“展望未来”试验将超重/肥胖且患有2型糖尿病的成年人随机分为接受ILI以减轻体重组，或糖尿病支持与教育（DSE）组。我们将来自四个研究地点的参与者数据与2000年美国人口普查数据相链接，以生成社区社会经济剥夺分数。我们使用具有随机截距以及剥夺三分位数与研究组之间4年交互项的混合效应线性模型，分析三分位数的社区剥夺对各种临床结局的影响，包括4年内体重和糖化血红蛋白（HbA1c）的变化。
在基线时的1213名参与者中，平均年龄为60岁，41%为男性，65%为白人，26%为黑人，4%为西班牙裔。大多数参与者拥有大学学位（84%），且报告年收入超过4万美元（75%）。在最贫困的三分位数中，剥夺分数范围为-12.04至-2.61，在最不贫困的三分位数中为2.01至18.69（分数越低，剥夺程度越高）。在4年期间，按剥夺分数划分，体重或HbA1c变化方面无统计学显著的治疗差异。
在该临床试验人群中，强化生活方式干预在社区社会经济剥夺的各个水平上效果相同。然而，这些发现可能不适用于收入和教育程度最低的个体，他们通常未纳入临床试验，对此还需要更多研究。
