The Diabetes Location, Environmental Attributes, and Disparities Network: Protocol for Nested Case Control and Cohort Studies, Rationale, and Baseline Characteristics

Abstract

Background Diabetes prevalence and incidence vary by neighborhood socioeconomic environment (NSEE) and geographic region in the United States. Identifying modifiable community factors driving type 2 diabetes disparities is essential to inform policy interventions that reduce the risk of type 2 diabetes. Objective This paper aims to describe the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network, a group funded by the Centers for Disease Control and Prevention to apply harmonized epidemiologic approaches across unique and geographically expansive data to identify community factors that contribute to type 2 diabetes risk. Methods The Diabetes LEAD Network is a collaboration of 3 study sites and a data coordinating center (Drexel University). The Geisinger and Johns Hopkins University study population includes 578,485 individuals receiving primary care at Geisinger, a health system serving a population representative of 37 counties in Pennsylvania. The New York University School of Medicine study population is a baseline cohort of 6,082,146 veterans who do not have diabetes and are receiving primary care through Veterans Affairs from every US county. The University of Alabama at Birmingham study population includes 11,199 participants who did not have diabetes at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort study with oversampling of participants from the Stroke Belt region. Results The Network has established a shared set of aims: evaluate mediation of the association of the NSEE with type 2 diabetes onset, evaluate effect modification of the association of NSEE with type 2 diabetes onset, assess the differential item functioning of community measures by geographic region and community type, and evaluate the impact of the spatial scale used to measure community factors. The Network has developed standardized approaches for measurement. Conclusions The Network will provide insight into the community factors driving geographical disparities in type 2 diabetes risk and disseminate findings to stakeholders, providing guidance on policies to ameliorate geographic disparities in type 2 diabetes in the United States. International Registered Report Identifier (IRRID) DERR1-10.2196/21377

Neighborhood Socioeconomic Environment and Risk of Type 2 Diabetes: Associations and Mediation Through Food Environment Pathways in Three Independent Study Samples

“…The Diabetes LEAD Network (hereafter, "the Network") is a 5-year (2017)(2018)(2019)(2020)(2021)(2022) research collaboration of four academic centers that is funded by the Centers for Disease Control and Prevention: one coordinating center (Drexel University) and three study sites: Geisinger and Johns Hopkins University (G/JHU), New York University Grossman School of Medicine (NYU), and the University of Alabama at Birmingham (18). The overarching goal of the Network is to iden-tify modifiable community determinants of T2D and cardiometabolic conditions using electronic health records (EHRs), administrative claims, and survey data from across the United States.…”

“…These issues pose challenges for (1) building a consistent body of literature across studies, populations, and geographies; (2) harmonizing analytic approaches across different study populations and designs; and, ultimately, (3) designing evidence-based policies to mitigate negative effects of community socioeconomic and food environment attributes. In this study, we aimed to measure the extent to which the relative availability of food-outlet types mediates an established inverse association between neighborhood socioeconomic conditions and T2D occurrence, using data from the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network (18). As part of this network, three independent study teams used the same environmental data sources and applied harmonized analytic methods to three distinct study samples to collectively evaluate these associations across four strata of community types, ranging from rural to higher density urban areas (18).…”

Longitudinal Analysis of Neighborhood Food Environment and Diabetes Risk in the Veterans Administration Diabetes Risk Cohort

“…More information about these neighborhood measures and the rationale for buffer sizes used has been published elsewhere. 17 Finally, to adjust for neighborhood demographic confounders that could influence the built environment and health outcomes, 2 US Census tract demographic measures from the American Community Survey-percentages of Hispanic and non-Hispanic Black residents-were included in the models as continuous variables.…”

Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA

“…This retrospective cohort study was conducted by Geisinger-Johns Hopkins Bloomberg School of Public Health, one of four academic research centers in the Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network ( ), a collaboration funded by the Centers for Disease Control and Prevention dedicated to providing scientific evidence to develop targeted community-based interventions and policies to prevent incident T2D and related health outcomes across the United States [ 18 ].…”