Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study

Usama Bilal, Felicia Hill-Briggs, Luis Sánchez-Perruca, Isabel Del Cura-González, Manuel Franco

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e021143
JournalBMJ Open
Volume8
Issue number9
DOIs
StatePublished - Oct 4 2018

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Electronic Health Records
Social Class
Spain
Social Conditions
Incidence
Glycosylated Hemoglobin A
Occupations
Primary Health Care
Regression Analysis
Education
Health
Population

Keywords

  • diabetes
  • neighborhoods
  • record linkage
  • social epidemiology
  • social inequalities
  • spain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain) : the HeartHealthyHoods study. / Bilal, Usama; Hill-Briggs, Felicia; Sánchez-Perruca, Luis; Del Cura-González, Isabel; Franco, Manuel.

In: BMJ Open, Vol. 8, No. 9, 04.10.2018, p. e021143.

Research output: Contribution to journalArticle

Bilal, Usama ; Hill-Briggs, Felicia ; Sánchez-Perruca, Luis ; Del Cura-González, Isabel ; Franco, Manuel. / Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain) : the HeartHealthyHoods study. In: BMJ Open. 2018 ; Vol. 8, No. 9. pp. e021143.
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AU - Del Cura-González, Isabel

AU - Franco, Manuel

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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.

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