Buchongo Portia, Chen Jie, Nguyen Quynh, White-Whilby Kellee, Kleinman Dushanka, Franzini Luisa
Johns Hopkins University School of Medicine, Division of General Internal Medicine, 2024 E Monument St, Baltimore, MD, 21205, USA.
University of Maryland School of Public Health, 4200 Valley Drive, 20742, College Park, MD, USA.
Health Place. 2025 Jul;94:103470. doi: 10.1016/j.healthplace.2025.103470. Epub 2025 Apr 30.
Transportation issues are a significant barrier for accessing the National Diabetes Prevention Program (NDPP), which remains an effective intervention to prevent type 2 diabetes. Although the link between neighborhood socioeconomic disadvantage and access to health care resources has been widely studied, its impact on travel time and access to NDPP has been underexplored.
Medicaid and private claims data for 2019 from the Maryland Medical Care Data Base were linked to 2019 Social Deprivation Index (SDI) data to measure neighborhood socioeconomic disadvantage. Google Distance Matrix Application Programming Interface key for Google Maps Platform was used to generate travel time estimates for enrollees diagnosed with prediabetes. Then adjusted generalized linear regression models using SDI quintiles and the interaction of SDI quintile and race and ethnicity were fitted to predict driving and public transit travel time to the nearest NDPP.
Enrollees living in neighborhoods with the highest SDI scores (most disadvantaged) had significantly shorter driving and public transit travel time to the nearest NDPP compared to enrollees living in neighborhoods with the lowest SDI scores (least disadvantaged). We found differences in the magnitude of shorter travel times across racial and ethnic groups and transportation mode.
Our findings fill a major gap in the literature on neighborhood socioeconomic disadvantage and travel time to NDPP. Findings highlight the role state policies may have had in expanding access to NDPP. More research is needed to examine strategies to address racial and ethnic disparities, and transportation needs to improve access to in-person NDPP.
交通问题是参与国家糖尿病预防计划（NDPP）的一个重大障碍，而该计划仍是预防2型糖尿病的有效干预措施。尽管邻里社会经济劣势与获得医疗保健资源之间的联系已得到广泛研究，但其对前往NDPP的出行时间和可及性的影响尚未得到充分探讨。
将来自马里兰州医疗保健数据库的2019年医疗补助和私人索赔数据与2019年社会剥夺指数（SDI）数据相链接，以衡量邻里社会经济劣势。使用谷歌地图平台的谷歌距离矩阵应用程序编程接口密钥来生成对被诊断为糖尿病前期的参保者的出行时间估计。然后拟合使用SDI五分位数以及SDI五分位数与种族和民族的交互作用的调整广义线性回归模型，以预测前往最近的NDPP的驾车和公共交通出行时间。
与生活在SDI得分最低（最不弱势）社区的参保者相比，生活在SDI得分最高（最弱势）社区的参保者前往最近的NDPP的驾车和公共交通出行时间明显更短。我们发现不同种族和民族群体以及交通方式在出行时间缩短幅度上存在差异。
我们的研究结果填补了关于邻里社会经济劣势与前往NDPP的出行时间的文献中的一个重大空白。研究结果突出了州政策在扩大NDPP可及性方面可能发挥的作用。需要更多研究来探讨解决种族和民族差异的策略，以及改善前往面对面NDPP服务的交通需求。
