Community-Level Social Determinants and the Burden of Diabetes in the Southeastern US

American Public Health Association (APHA) Annual Meeting, November 10-14, 2018, San Diego, California

Gargya Malla, MBBS, MPH, PhD Student, D. Leann Long, PhD, Nyesha Black, PhD, Andrea Cherrington, MD, MPH, Gareth Dutton, PhD, Monika Safford, MD, Doyle Cummings, PharmD, Suzanne Judd, PhD, Emily Levitan, ScD and April Carson, PhD, MSPH,

BACKGROUND: In the US, stark geographic disparities exist in the prevalence of diabetes. A CDC-funded collaboration, The Diabetes LEAD (Location, Environmental Attributes & Disparities) Network, was formed to investigate community-level factors associated with the greater burden of diabetes in certain geographic areas in the US.

OBJECTIVES: The University of Alabama at Birmingham research site will focus on identifying community-level and individual-level social determinants that contribute to a greater burden of diabetes in the southeastern US. We will leverage data from a prospective cohort study, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, to investigate contributing factors to county-level disparities in Alabama, Georgia, South Carolina, North Carolina, and Virginia.

METHODS: This secondary data analysis included 30, 183 black and white adults age > 45 years at baseline (2003-2007) from the REGARDS Study. Questionnaires and an in-home physical exam were completed to assess anthropometrics, blood pressure, and medical history and collect blood and urine samples. Household income (median income; median value of housing unit; % households receiving interest, dividend, or rental income), education (% with high school education; % with college degree), and occupation (% employed in executive or professional occupations) data at the census-tract level was used to create race-specific community-level socioeconomic z-scores. Higher community-level socioeconomic z-scores reflected higher socioeconomic status. The association of race-specific quartiles of community-level scores with prevalent diabetes was investigated using modified Poisson regression.

RESULTS: The overall prevalence of diabetes was 22%, and was higher for black adults (29%) than white adults (15%). The median neighborhood score for black participants was -3.19 (SD=3.92) and was 0.87 (SD=5.55) for white participants. Black and white participants with lower community-level scores were more likely to be female, have higher BMI, be current smokers, and have a history of myocardial infarction. After adjustment for demographic and clinical factors, low community-level socioeconomic score (quartile 1 vs quartile 4) was associated with prevalent diabetes among black adults (PR=1.17; 95% CI=1.03, 1.32) but not among white adults (PR=1.09; 95% CI=0.99, 1.19).

CONCLUSION:The prevalence of diabetes varied by community-level social determinants, with a greater burden of prevalent diabetes at lower community-level socioeconomic scores. These preliminary results suggest our proposal to expand beyond community-level socioeconomic factors is warranted. Future research will investigate nine domains of social determinants at the community-level (i.e., income and wealth; housing; health systems and services; employment; education; transportation; social environment; public safety; and physical environment) to inform the development of targeted community-level programs and policies for diabetes prevention.