The Effect of Adverse Housing and Neighborhood Conditions on the Development of Diabetes Mellitus among Middle-aged African Americans

Abstract

The authors examined the associations of observed neighborhood (block face) and housing conditions with the incidence of diabetes by using data from 644 subjects in the African-American Health Study (St. Louis area, Missouri). They also investigated five mediating pathways (health behavior, psychosocial, health status, access to medical care, and sociodemographic characteristics) if significant associations were identified. The external appearance of the block the subjects lived on and housing conditions were rated as excellent, good, fair, or poor. Subjects reported about neighborhood desirability. Self-reported diabetes was obtained at baseline and 3 years later. Of 644 subjects without self-reported diabetes, 10.3% reported having diabetes at the 3-year follow-up. Every housing condition rated as fair-poor was associated with an increased risk Correspondence to Dr. Mario Schootman, Division of Health Behavior Research, Washington University, 4444 Forest Park Boulevard, Box 8504, St. Louis, MO 63108 (mschootm@im.wustl.edu). For permissions, please e-mail: journals.permissions@oxfordjournals.org.Editor's note: An invited commentary on this article appears on page 388, and the authors' response is published on page 391. Conflict of interest: none declared. HHS Public AccessAuthor manuscript Am J Epidemiol. Author manuscript; available in PMC 2015 July 29. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript of diabetes, with odds ratios ranging from 2.53 (95% confidence interval: 1.47, 4.34 for physical condition inside the building) to 1.78 (95% confidence interval: 1.03, 3.07 for cleanliness inside the building) in unadjusted analyses. No association was found between any of the block face conditions or perceived neighborhood conditions and incident diabetes. The odds ratios for the five housing conditions were unaffected when adjusted for the mediating pathways. Poor housing conditions appear to be an independent contributor to the risk of incident diabetes in urban, middle-aged African Americans. KeywordsAfrican Americans; aging; diabetes mellitus; housing; questionnaires; residence characteristics Diabetes mellitus is now approaching epidemic proportions (1). In the United States, the prevalence and incidence of diabetes increased dramatically during the past two decades (1) such that diabetes now affects about 20.8 million people or 7 percent of the population (2). The number of individuals with diagnosed diabetes is estimated to triple by the year 2050 (3).African Americans are more likely than Whites to develop diabetes (4). Estimates show that 3.2 million African Americans currently have diabetes (5). The number of African Americans with diabetes is projected to triple by the year 2050, but the number is estimated to only double among Whites (3).While the pathogenesis of diabetes is complex, a number of factors have been identified that increase the risk of the disease. In addition to African-American race, they include increased body mass index, age 45 years or older, physica...

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Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995–2008

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