TY - JOUR
T1 - Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes
T2 - Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples
AU - Thorpe, Lorna E.
AU - Adhikari, Samrachana
AU - Lopez, Priscilla
AU - Kanchi, Rania
AU - McClure, Leslie A.
AU - Hirsch, Annemarie G.
AU - Howell, Carrie R.
AU - Zhu, Aowen
AU - Alemi, Farrokh
AU - Rummo, Pasquale
AU - Ogburn, Elizabeth L.
AU - Algur, Yasemin
AU - Nordberg, Cara M.
AU - Poulsen, Melissa N.
AU - Long, Leann
AU - Carson, April P.
AU - De Silva, Shanika A.
AU - Meeker, Melissa
AU - Schwartz, Brian S.
AU - Lee, David C.
AU - Siegel, Karen R.
AU - Imperatore, Giuseppina
AU - Elbel, Brian
N1 - Funding Information:
This research was conducted by the Diabetes LEAD Network, funded by the Centers for Disease Control and Prevention (CDC) cooperative agreements U01DP006293 (Drexel University), U01DP006296 (Geisinger-Johns Hopkins University), U01DP006299 (New York University School of Medicine), and U01DP006302 (University of Alabama at Birmingham), along with collaboration with the CDC Division of Diabetes Translation. The study was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant R01DK124400). The REGARDS Study was supported by Cooperative agreementU01 NS041588, cofunded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, National Institutes of Health, Department of Health and Human Services.
Funding Information:
Funding. This research was conducted by the Diabetes LEAD Network, funded by the Centers for Disease Control and Prevention (CDC) cooperative agreements U01DP006293 (Drexel University), U01DP006296 (Geisinger–Johns Hopkins University), U01DP006299 (New York University School of Medicine), and U01DP006302 (University of Alabama at Birmingham), along with collaboration with the CDC Division of Diabetes Translation. The study was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant R01DK124400). The REGARDS Study was supported by cooperative agreement U01 NS041588, cofunded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, National Institutes of Health, Department of Health and Human Services.
Publisher Copyright:
© 2022 by the American Diabetes Association.
PY - 2022/4
Y1 - 2022/4
N2 - OBJECTIVE: We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract-level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: Higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS: Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE-diabetes associations were mediated through food-environment pathways. CONCLUSIONS: Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.
AB - OBJECTIVE: We examined whether relative availability of fast-food restaurants and supermarkets mediates the association between worse neighborhood socioeconomic conditions and risk of developing type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: As part of the Diabetes Location, Environmental Attributes, and Disparities Network, three academic institutions used harmonized environmental data sources and analytic methods in three distinct study samples: 1) the Veterans Administration Diabetes Risk (VADR) cohort, a national administrative cohort of 4.1 million diabetes-free veterans developed using electronic health records (EHRs); 2) Reasons for Geographic and Racial Differences in Stroke (REGARDS), a longitudinal, epidemiologic cohort with Stroke Belt region oversampling (N = 11,208); and 3) Geisinger/Johns Hopkins University (G/JHU), an EHR-based, nested case-control study of 15,888 patients with new-onset T2D and of matched control participants in Pennsylvania. A census tract-level measure of neighborhood socioeconomic environment (NSEE) was developed as a community type-specific z-score sum. Baseline food-environment mediators included percentages of 1) fast-food restaurants and 2) food retail establishments that are supermarkets. Natural direct and indirect mediating effects were modeled; results were stratified across four community types: Higher-density urban, lower-density urban, suburban/small town, and rural. RESULTS: Across studies, worse NSEE was associated with higher T2D risk. In VADR, relative availability of fast-food restaurants and supermarkets was positively and negatively associated with T2D, respectively, whereas associations in REGARDS and G/JHU geographies were mixed. Mediation results suggested that little to none of the NSEE-diabetes associations were mediated through food-environment pathways. CONCLUSIONS: Worse neighborhood socioeconomic conditions were associated with higher T2D risk, yet associations are likely not mediated through food-environment pathways.
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U2 - 10.2337/dc21-1693
DO - 10.2337/dc21-1693
M3 - Article
C2 - 35104336
AN - SCOPUS:85128160404
SN - 0149-5992
VL - 45
SP - 798
EP - 810
JO - Diabetes Care
JF - Diabetes Care
IS - 4
ER -