Environmental and Socio-Economic Factors as Contributors to Racial Disparities in Diabetes Prevalence

LaVeist, Thomas A.; Thorpe, Roland J.; Galarraga, Jessica E.; Bower, Kelly M.; Gary-Webb, Tiffany L.

doi:10.1007/s11606-009-1085-7

Cited by 122 publications

(107 citation statements)

References 19 publications

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“…27 In fact, prior EHDIC analyses found minimal racial disparities in hypertension, obesity and diabetes, and those findings are largely attributable to relatively high disease prevalence in whites. [28][29][30] Secondly, income, which is a consistent predictor of hypertension elsewhere, 27,31 was not associated with blood pressure levels or with risk of hypertension in this sample. This is likely because the community mean income is near the poverty threshold and there is little variability in income, so poverty exposure is homogeneous within the sample.…”

Section: Discussionmentioning

confidence: 57%

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Samuel

Thorpe²,

Bower³

et al. 2015

J Urban Health

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Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant's block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (β=−2.020, p=0.028; β=−4.132, p=0.010) and diastolic (β=−1.261, p=0.038; β=−2.290, 0.031) blood pressure, respectively, among whites (n=548). Social cohesion was associated with higher systolic (β=4.905, p=0.009) and diastolic blood pressure (β=3.379, p=0.008) among African Americans (n=777). In one racially integrated lowincome community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.

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Section: Discussionmentioning

confidence: 57%

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Samuel

Thorpe²,

Bower³

et al. 2015

J Urban Health

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“…L ower socioeconomic status (SES) groups in the U.S. suffer excess disease burden from type 2 diabetes. 1,2 This excess burden is mediated by risk factors such as hyperglycemia, hypertension, and dyslipidemia, which are modifiable with medical management and lifestyle changes. Patient diabetes education is recommended to facilitate patient selfmanagement of these risk factors.…”

mentioning

confidence: 99%

Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample

et al. 2011

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BACKGROUND: Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to selfcare, and facilitating behavior change. OBJECTIVE: To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility. DESIGN: Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis. PARTICIPANTS: Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization. INTERVENTIONS: A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial. MAIN MEASURES: Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline). RESULTS: Adoption of both programs was high (>85% attendance rates, 95% retention). At 3 months postintervention, the between-group difference in A1C change was −0.72% (p =0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up (ß = −0.13, p=0.04). Intensive program patients demonstrated within-

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“…This can pose a significant problem when relying on national data to understand and inform men's health disparities. 17,[20][21][22] There are three explanations for these findings. First, the EHDIC study design represents an opportunity to begin to disentangle race and residential segregation to better understand health disparities among men.…”

Section: Discussionmentioning

confidence: 99%

Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men

et al. 2014

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Disparities in men's health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR]=1.58, 95 % confidence interval [CI] 1.34, 1.86) and diabetes (OR=1.62, 95 % CI 1.27-2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR=1.05, 95 % CI 0.70, 1.59) and diabetes (OR=1.12, 95 % CI 0.57-2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.

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Environmental and Socio-Economic Factors as Contributors to Racial Disparities in Diabetes Prevalence

Cited by 122 publications

References 19 publications

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample

Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men

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