Using data from the United States Behavioral Risk Factor Surveillance System (2003–2012; N = 3,397,124 adults), we estimated associations between prevalent diabetes and four county-level exposures (fast food restaurant density, convenience store density, unemployment, active commuting). All associations confirmed our a priori hypotheses in conventional multilevel analyses that pooled across years. In contrast, using a random-effects within-between model, we found weak, ambiguous evidence that within-county changes in exposures were associated with within-county change in odds of diabetes. Decomposition revealed that the pooled associations were largely driven by time-invariant, between-county factors that may be more susceptible to confounding versus within-county associations.
- Built environment
- Multilevel modeling
ASJC Scopus subject areas
- Health(social science)
- Sociology and Political Science
- Life-span and Life-course Studies