Lam Vincent, Sharma Shivam, Alvarez Christian S, King Jordan I, Mariño-Ramírez Leonardo
National Institutes of Health.
Georgia Institute of Technology.
Res Sq. 2025 May 7:rs.3.rs-6315181. doi: 10.21203/rs.3.rs-6315181/v1.
Social determinants of health (SDOH) play a strong role in influencing type 2 diabetes (T2D) risk. Certain protective SDOH have been demonstrated to mitigate or buffer against the positive associations between risk-associated SDOH and poor health outcomes, though such buffering effects have only been evaluated among a limited range of SDOH and outside the context of T2D. This study aims to assess potential buffering effects among SDOH associated with T2D case status.
The study population was constructed from Research Program data. Survey data were used to derive composite metrics measuring 10 different SDOH. Logistic regression models modeling T2D case status as a function of each SDOH were used to designate each as either a T2D risk-associated or protective factor. Interaction models were used to measure potential buffering effects between T2D risk-associated and protective factors.
The main study population consists of 215,270 participants. All ten SDOH were significantly associated with T2D. Social support and neighborhood cohesion emerged as T2D protective factors, with the rest being classified as risk-associated factors for T2D. A single buffering effect was observed between social support and stress (β = 0.43, p <0.05) (95% CI, -0.84 to -0.01). Reverse buffering effects were observed between neighborhood cohesion and discrimination, food insecurity, and individual-level socioeconomic deprivation (SED). Reverse buffering effects were also observed between social support and food insecurity, individual-level SED, and spirituality.
The buffering effect observed between social support and stress on T2D is consistent with previous findings. The reverse buffering effects observed in interactions between certain SDOH factors suggest that some risk-associated SDOH may weaken the potential benefits of certain protective SDOH. Interventions aimed at alleviating adverse socioeconomic conditions may have a compounding effect on reducing T2D risk by enabling communities to benefit from T2D protective factors.
健康的社会决定因素（SDOH）在影响2型糖尿病（T2D）风险方面发挥着重要作用。某些具有保护作用的SDOH已被证明可以减轻或缓冲与风险相关的SDOH与不良健康结果之间的正相关关系，不过这种缓冲作用仅在有限范围的SDOH中以及在T2D背景之外进行了评估。本研究旨在评估与T2D病例状态相关的SDOH之间的潜在缓冲作用。
研究人群来自研究项目数据。调查数据用于得出衡量10种不同SDOH的综合指标。使用将T2D病例状态作为每个SDOH函数的逻辑回归模型，将每个因素指定为与T2D风险相关的因素或保护因素。交互模型用于测量与T2D风险相关的因素和保护因素之间的潜在缓冲作用。
主要研究人群包括215,270名参与者。所有10种SDOH均与T2D显著相关。社会支持和社区凝聚力成为T2D的保护因素，其余因素被归类为T2D的风险相关因素。在社会支持和压力之间观察到单一的缓冲作用（β = 0.43，p <0.05）（95%置信区间，-0.84至-0.01）。在社区凝聚力与歧视、粮食不安全和个体层面的社会经济剥夺（SED）之间观察到反向缓冲作用。在社会支持与粮食不安全、个体层面的SED和精神信仰之间也观察到反向缓冲作用。
社会支持和压力对T2D的缓冲作用与先前的研究结果一致。在某些SDOH因素之间的相互作用中观察到的反向缓冲作用表明，一些与风险相关的SDOH可能会削弱某些保护作用的SDOH的潜在益处。旨在缓解不利社会经济状况的干预措施可能会通过使社区从T2D保护因素中受益，对降低T2D风险产生复合效应。
