Relationship of neighborhood and individual socioeconomic characteristics to type 2 diabetes, hyperinsulinemia, and impaired fasting glucose: the Atherosclerosis Risk in Communities study, 1987-1998 Public Deposited

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  • March 22, 2019
Creator
  • Jackson, Seronda Arlette
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Neighborhood socioeconomic characteristics are inversely related to the prevalence and incidence of coronary heart disease, but little is known about their association with diabetes. We investigated whether neighborhood- and individual- level socioeconomic characteristics are associated with Type 2 diabetes prevalence and incidence and the prevalence of hyperinsulinemia and impaired fasting glucose, whether neighborhood associations persisted after adjusting for individual level social class indicators, and whether the effects of individual level indicators varied across neighborhoods. The study sample consisted of 10,721 African American and white men and women aged 45-64 at the baseline examination of the Atherosclerosis Risk in Communities study. Participants were sampled from four United States communities: Forsyth County, North Carolina; Washington County, Maryland; the northwestern suburbs of Minneapolis, Minnesota; and Jackson, Mississippi. Census tracts were used as proxies for neighborhoods. A summary score for neighborhood characteristics was constructed from indicators of wealth, income, education, and occupation from the 1990 U.S. Census. Age-adjusted multilevel models including neighborhood characteristics and individual level indicators (household income, education, and occupation) were fit separately for each race-gender group. Individual income, education, and occupation were inversely associated with diabetes prevalence for all race-gender subgroups. There were no clear, consistent patterns of association between individual level indicators and hyperinsulinemia and impaired fasting glucose. Individual level indicators were generally inversely associated with diabetes incidence in most subgroups, except among African American men, in whom education and occupation were directly associated with diabetes incidence. Neighborhood characteristics were inversely associated with the prevalence of diabetes and impaired fasting glucose among women only. There was not a clear pattern of association between neighborhood characteristics and prevalence of hyperinsulinemia. Diabetes incidence was inversely related to neighborhood characteristics among whites only. There was a direct association for African American women and no clear pattern of association among African American men. Associations with individual level indicators did not vary systematically across neighborhoods. Individual level socioeconomic indicators generally were associated with diabetes, hyperinsulinemia, and impaired fasting glucose in this biracial cohort. Living in disadvantaged neighborhoods was not consistently associated with increased prevalence of diabetes, hyperinsulinemia, or impaired fasting glucose or incidence of diabetes.
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  • In Copyright
Advisor
  • Heiss, Gerardo
Degree granting institution
  • University of North Carolina at Chapel Hill
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  • Open access