TY - JOUR
T1 - Association of community types and features in a case-control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania
AU - Schwartz, B. S.
AU - Pollak, Jonathan
AU - Poulsen, Melissa N.
AU - Bandeen-Roche, Karen
AU - Moon, Katherine
AU - Dewalle, Joseph
AU - Siegel, Karen
AU - Mercado, Carla
AU - Imperatore, Giuseppina
AU - Hirsch, Annemarie G.
N1 - Funding Information:
Funding This publication was made possible by Cooperative Agreement Number DP006293 funded by the US Centers for Disease Control and Prevention, Division of Diabetes Translation.
Publisher Copyright:
©
PY - 2021/1/13
Y1 - 2021/1/13
N2 - Objectives To evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions. Design Nested case-control study within the open dynamic cohort of health system patients. Setting Large, integrated health system in 37 counties in central and northeastern Pennsylvania, USA. Participants and analysis We used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types. Results Borough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds. Conclusions Urban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.
AB - Objectives To evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions. Design Nested case-control study within the open dynamic cohort of health system patients. Setting Large, integrated health system in 37 counties in central and northeastern Pennsylvania, USA. Participants and analysis We used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types. Results Borough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds. Conclusions Urban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.
KW - diabetes & endocrinology
KW - epidemiology
KW - public health
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U2 - 10.1136/bmjopen-2020-043528
DO - 10.1136/bmjopen-2020-043528
M3 - Article
C2 - 33441365
AN - SCOPUS:85099394181
SN - 2044-6055
VL - 11
JO - BMJ open
JF - BMJ open
IS - 1
M1 - e043528
ER -