County-level contextual factors associated with diabetes incidence in the United States

• Type of Material: Article
• Authors: Solveig A. Cunningham, Emory University; Shivani Patel, Emory University; Gloria L. Beckles, Centers for Disease Control and Prevention; Linda S. Geiss, Centers for Disease Control and Prevention; Neil Mehta, Emory University; Hui Xie, Centers for Disease Control and Prevention; Giuseppina Imperatore, Centers for Disease Control and Prevention
• Language: English
• Date: 2018-01-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2017.11.002
• Title of Journal or Parent Work: Annals of Epidemiology
• ISSN: 1047-2797
• Volume: 28
• Issue: 1
• Start Page: 20
• End Page: 25
• Grant/Funding Information: Neil Mehta was supported by the National Institute on Aging [grant number R01-AG040212].; Shivani Patel and Neil Mehta were supported by funding from the Robert Wood Foundation [grant number 70769].
• Keywords: Public, Environmental & Occupational Health; MORTALITY; Social determinants of health; US ADULTS; Geographic variation; RISK-FACTORS; Science & Technology; HEALTH; Health disparities; Diabetes; Disease incidence; Built environment; MULTILEVEL ANALYSIS; PREVALENCE; Life Sciences & Biomedicine
• Research Categories: Sociology, Public and Social Welfare; Health Sciences, Public Health

Abstract

Purpose: Health and administrative systems are facing spatial clustering in chronic diseases such as diabetes. This study explores how geographic distribution of diabetes in the United States is associated with socioeconomic and built environment characteristics and health-relevant policies. Methods: We compiled nationally representative county-level data from multiple data sources. We standardized characteristics to a mean = 0 and a SD = 1 and modeled county-level age-adjusted diagnosed diabetes incidence in 2013 using 2-level hierarchical linear regression. Results: Incidence of age-standardized diagnosed diabetes in 2013 varied across U.S. counties (n = 3109), ranging from 310 to 2190 new cases/100,000, with an average of 856.4/100,000. Socioeconomic and health-related characteristics explained ∼42% of the variation in diabetes incidence across counties. After accounting for other characteristics, counties with higher unemployment, higher poverty, and longer commutes had higher incidence rates than counties with lower levels. Counties with more exercise opportunities, access to healthy food, and primary care physicians had fewer diabetes cases. Conclusions: Features of the socioeconomic and built environment were associated with diabetes incidence; identifying the salient modifiable features of counties can inform targeted policies to reduce diabetes incidence.