TY - JOUR
T1 - Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain)
T2 - The Heart Healthy Hoods study
AU - Bilal, Usama
AU - Hill-Briggs, Felicia
AU - Sánchez-Perruca, Luis
AU - Del Cura-González, Isabel
AU - Franco, Manuel
N1 - Funding Information:
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 2Social and Cardiovascular Epidemiology Research Group, Universidad de Alcalá, Madrid, Spain 3Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, USA 4Welch Center for Prevention, Epidemiology and Clinical Research, Hopkins Medical Institutions, Baltimore, Maryland, USA 5The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 6Primary Care Management, Madrid Health Service, Madrid, Spain 7Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain 8Primary Care Research Unit, Primary Care Management. Madrid Health Service, Madrid, Spain 9Area of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain Acknowledgements UB was supported by a Johns Hopkins Center for a Livable Future – Lerner Fellowship and a Postgraduate Fellowship from the Obra Social La Caixa.
Funding Information:
Funding MF was supported by the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007– 2013/ERC Starting Grant HeartHealthyHoods Agreement n. 336893). FHB was supported by the National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Research Center (P30DK079637).
Publisher Copyright:
© Author(s) (or their employer(s)) 2018.
PY - 2018
Y1 - 2018
N2 - Objective To study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain. Setting Electronic health records of the primary-care system in four districts of Madrid (Spain). Participants 269 942 people aged 40 or older, followed from 2013 to 2014. Exposure Neighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions. Primary outcome measures Diagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %). Results In regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15). Conclusions Diabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.
AB - Objective To study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain. Setting Electronic health records of the primary-care system in four districts of Madrid (Spain). Participants 269 942 people aged 40 or older, followed from 2013 to 2014. Exposure Neighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions. Primary outcome measures Diagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %). Results In regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15). Conclusions Diabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.
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U2 - 10.1136/bmjopen-2017-021143
DO - 10.1136/bmjopen-2017-021143
M3 - Article
C2 - 30287604
AN - SCOPUS:85054433096
VL - 8
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 9
M1 - e021143
ER -