Mah Sarah M, Hurst Mackenzie, Lu Mindy, Rosella Laura C
University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.
Geography and Geosciences, University of Vermont, Burlington, Vermont, USA.
BMJ Public Health. 2025 Sep 5;3(2):e001560. doi: 10.1136/bmjph-2024-001560. eCollection 2025.
Community belonging is a dimension of subjective well-being that is of growing public health interest for mitigating chronic disease. However, there is limited longitudinal evidence that such a relationship exists. We assessed the effect of community belonging on the subsequent 5-year risk of diabetes.
This population-based cohort study consisted of 132 295 Ontario respondents of the Canadian Community Health Survey (2000-2014) aged 30-75 years and diabetes-free. Individuals were linked to a validated diabetes registry and followed for 5 years or until 31 March 2020. Survey respondents rated their sense of belonging to community on a 4-point scale (very strong, somewhat strong, somewhat weak or very weak belonging). We estimated the effect of community belonging on 5-year diabetes incidence using Cox proportional hazards models. Inverse probability of treatment weighting (IPTW) was used to account for sociodemographic and behavioural confounders. Analyses were also stratified, weighted and modelled by key individual-level characteristics.
At survey response, 9.5% of the sample reported having very weak sense of belonging to their communities. By the end of study follow-up, 5.3% of the sample developed diabetes. IPT weighting achieved balance between community belonging groups across the sample and subgroups. Respondents with a very weak sense of belonging exhibited higher risk of diabetes (HR 1.26, 95% CI 1.09 to 1.46, compared with those with somewhat weak, somewhat strong and very strong sense of belonging), even after accounting for individual-level factors via IPTW (HR 1.16, 95% CI 1.01, 1.34). Those with very weak belonging exhibited elevated risk of diabetes across most subgroups, and this association remained conclusive after IPT weighting for Canadian-born and white participants.
The association between weak sense of belonging to community and diabetes risk demonstrated by this study highlights the critical role that social connections play in chronic disease epidemiology. Our findings signal a need to include social and community factors in population health strategies for chronic disease prevention.
社区归属感是主观幸福感的一个维度，对于缓解慢性病而言，其在公共卫生方面的重要性日益凸显。然而，纵向证据表明这种关系存在的情况有限。我们评估了社区归属感对后续5年患糖尿病风险的影响。
这项基于人群的队列研究包括132295名年龄在30至75岁之间且无糖尿病的安大略省加拿大社区健康调查（2000 - 2014年）受访者。个体与经过验证的糖尿病登记处建立联系，并随访5年或直至2020年3月31日。调查受访者用4分制（非常强烈、有点强烈、有点微弱或非常微弱的归属感）对他们的社区归属感进行评分。我们使用Cox比例风险模型估计社区归属感对5年糖尿病发病率的影响。采用逆概率处理加权法（IPTW）来考虑社会人口统计学和行为混杂因素。分析还按关键个体层面特征进行分层、加权和建模。
在调查回复时，9.5%的样本报告称对其社区的归属感非常微弱。到研究随访结束时，5.3%的样本患上了糖尿病。IPTW在整个样本和亚组的社区归属感群体之间实现了平衡。归属感非常微弱的受访者患糖尿病的风险更高（与归属感有点微弱、有点强烈和非常强烈的受访者相比，风险比[HR]为1.26，95%置信区间[CI]为1.09至1.46），即使在通过IPTW考虑个体层面因素后（HR为1.16，95%CI为1.01，1.34）。归属感非常微弱的人在大多数亚组中患糖尿病的风险都有所升高，并且在对加拿大出生和白人参与者进行IPTW加权后，这种关联仍然具有决定性。
本研究表明社区归属感薄弱与糖尿病风险之间的关联凸显了社会联系在慢性病流行病学中所起的关键作用。我们的研究结果表明，有必要将社会和社区因素纳入慢性病预防的人群健康策略中。
