Jennifer A Campbell1,2,3, Alice Yan3, Renee E Walker3, Lance Weinhardt3, Yang Wang3, Rebekah J Walker1,2, Leonard E Egede4,5. 1. Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA. 2. Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA. 3. Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA. 4. Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA. legede@mcw.edu. 5. Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA. legede@mcw.edu.
Abstract
BACKGROUND: Health disparities disproportionately impact inner-city African Americans; however, limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes in this population. METHODS: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A conceptual framework was used to specify measurements across the individual level, such as age and comorbidities; community level, such as neighborhood factors and support; and health system level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health system factors and regressed against HbA1c. RESULTS: In the final adjusted model across all four approaches, individual-level factors like age (β = - 0.05; p < 0.001); having 1-3 comorbidities (β = - 2.03; p < 0.05), and having 4-9 comorbidities (β = - 2.49; p = 0.001) were associated with poorer glycemic control. Similarly, male sex (β = 0.58; p < 0.05), being married (β = 1.16; p = 0.001), and being overweight/obese (β = 1.25; p < 0.01) were associated with better glycemic control. Community and health system-level factors were not significantly associated with glycemic control. CONCLUSION: Individual-level factors are key drivers of glycemic control among inner-city African Americans. These factors should be the key targets for interventions to improve glycemic control in this population. However, community and health system factors may have indirect pathways to glycemic control that should be examined in future studies.
BACKGROUND: Health disparities disproportionately impact inner-city African Americans; however, limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes in this population. METHODS: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A conceptual framework was used to specify measurements across the individual level, such as age and comorbidities; community level, such as neighborhood factors and support; and health system level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health system factors and regressed against HbA1c. RESULTS: In the final adjusted model across all four approaches, individual-level factors like age (β = - 0.05; p < 0.001); having 1-3 comorbidities (β = - 2.03; p < 0.05), and having 4-9 comorbidities (β = - 2.49; p = 0.001) were associated with poorer glycemic control. Similarly, male sex (β = 0.58; p < 0.05), being married (β = 1.16; p = 0.001), and being overweight/obese (β = 1.25; p < 0.01) were associated with better glycemic control. Community and health system-level factors were not significantly associated with glycemic control. CONCLUSION: Individual-level factors are key drivers of glycemic control among inner-city African Americans. These factors should be the key targets for interventions to improve glycemic control in this population. However, community and health system factors may have indirect pathways to glycemic control that should be examined in future studies.
Entities:
Keywords:
Community; Diabetes; Health system; Individual; Inner-city African American; Social determinants of health
Authors: Arleen F Brown; Edward W Gregg; Mark R Stevens; Andrew J Karter; Morris Weinberger; Monika M Safford; Tiffany L Gary; Dorothy A Caputo; Beth Waitzfelder; Catherine Kim; Gloria L Beckles Journal: Diabetes Care Date: 2005-12 Impact factor: 19.112
Authors: Gijs W Landman; Kornelis J J van Hateren; Nanne Kleefstra; Klaas H Groenier; Rijk O B Gans; Henk J G Bilo Journal: Br J Gen Pract Date: 2010-03 Impact factor: 5.386
Authors: Mercedes R Carnethon; Jia Pu; George Howard; Michelle A Albert; Cheryl A M Anderson; Alain G Bertoni; Mahasin S Mujahid; Latha Palaniappan; Herman A Taylor; Monte Willis; Clyde W Yancy Journal: Circulation Date: 2017-10-23 Impact factor: 29.690
Authors: Matthew P Goldman; Christopher J Clark; Timothy E Craven; Ross P Davis; Timothy K Williams; Gabriela Velazquez-Ramirez; Justin B Hurie; Matthew S Edwards Journal: J Am Coll Surg Date: 2018-10-16 Impact factor: 6.113
Authors: Darrell J Gaskin; Roland J Thorpe; Emma E McGinty; Kelly Bower; Charles Rohde; J Hunter Young; Thomas A LaVeist; Lisa Dubay Journal: Am J Public Health Date: 2013-11-14 Impact factor: 9.308