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Diabetes control is associated with environmental quality in the USA
Citation:
Jagai, J., A. Krajewski, K. Price, D. Lobdell, AND R. Sargis. Diabetes control is associated with environmental quality in the USA. Journal of Diabetes Investigation. John Wiley & Sons, Inc., Hoboken, NJ, 10(9):1018-1026, (2021). https://doi.org/10.1530/EC-21-0132
Impact/Purpose:
This study addresses research questions under Sustainable and Healthy Communities (10.2.9). Center for Public Health and Environmental Assessment in the Public Health and Environmental Systems Division, Epidemiology Branch is currently engaged in research aimed at developing a measure that estimates overall environmental quality at the county level across the U.S. spanning the years 2006 – 2010 called the Environmental Quality Index (EQI). This work is being conducted for the purpose of learning more about how various environmental factors contribute in concert to health disparities in low-income, underrepresented minority and vulnerable populations, and to better estimate the total environmental and social context to which humans are exposed. The EQI was used to assess associations between cumulative environmental exposures and diabetes control in the U.S.
Description:
Environmental parameters, including built and sociodemographic environments, can impact diabetes control (DC). Epidemiological studies have associated specific environmental factors with DC; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI), a comprehensive quantitative metric capturing five environmental domains, was considered as an exposure. Age-adjusted rates of DC prevalence for each county in the United States were used as an outcome. DC was defined as the proportion of adults aged 20+ years with a previous diabetes diagnosis who currently do not have high fasting blood glucose (≥126 mg/dL) or elevated HbA1c (≥6.5). We conducted county-level analyses of DC prevalence rates for the years 2004–2012 in association with EQI for 2006–2010 and domain-specific indices using random intercept multilevel linear regression models clustered by state and controlled for county-level rates of obesity and physical inactivity. Analyses were stratified by rural–urban strata, and results are reported as prevalence rate differences (PRD) with 95% CIs comparing highest quintile/worst environmental quality to lowest quintile/best environmental quality. The association of DC with cumulative environmental quality was negative after control for all counties (PRD −0.32, 95% CI: −0.38, −0.27); suggesting that rates of DC worsen as environmental quality declines. While overall environmental quality exerts effects on DC that vary across the rural–urban spectrum, poor sociodemographic, and built environmental factors are associated with decreased DC nationally. These data suggest improvements in environmental quality mediated by larger-scale policy and practice interventions may improve glycemic control and reduce the morbidity and mortality arising from hyperglycemia.
