Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population

2021
Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies. Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction. Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (-0.028, -0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction. Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.
FRONTIERS IN PUBLIC HEALTH
卷号:8
收录类型
SSCI
发表日期
2021
学科领域
循证公共卫生
国家
美国
语种
英语
DOI
10.3389/fpubh.2020.633340
其他关键词
GLYCEMIC CONTROL; AGE; PREVENTION
EISSN
2296-2565
被引频次(WOS)
0
被引更新日期
2022-01
来源机构
University of Texas System University of Texas Health Science Center Houston University of Texas School Public Health University of Texas System University of Texas Health Science Center Houston University of Texas System University of Texas Health Science Center Houston University of Texas System University of Texas Health Science Center Houston University of Texas School Public Health
关键词
diabetes social determinants of health Mexican Americans chronic disease management multilevel modeling Bayesian spatial