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The association between environmental quality and diabetes control in the U.S.
Citation:
Jagai, J., A. Krajewski, K. Price, D. Lobdell, AND R. Sargis. The association between environmental quality and diabetes control in the U.S. SER, Minneapolis, Minnesota, June 18 - 21, 2019.
Impact/Purpose:
This study utilizes the EPA created Environmental Quality Index to assess the impact of overall environmental quality on diabetes control.
Description:
Environmental parameters, especially built and sociodemographic environments, can impact the ability to con-trol diabetes. Epidemiological studies have associated specific environmental factors and diabetes control; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI) is a novel and comprehensive quantitative metric that captures five environmental domains for 2000-2005. We conducted county-level analyses of age-adjusted diabetes control, defined as the proportion of adults age 20+ with a previous diabetes diagnosis and/or high fasting blood glucose who currently do not have high fasting blood glucose, prevalence rates, for 2004-2012, in association with the EQI and domain-specific indices using random intercept multilevel linear regression models clustered by state, controlling for county-level rates of obesity and physical inactivity. Analyses were stratified by four rural-urban strata, and re-sults are reported as prevalence rate differences (PRD) with 95% CIs comparing highest quintile/worst envi-ronmental quality to lowest quintile/best domain specific quality. Decreased overall environmental quality was associated with increased diabetes control across all counties (PRD:1.09, 95%CI:1.04,1.14) and in more urban areas; however, poorer overall environmental quality was associated with reduced diabetes control in more ru-ral counties. For all counties, poorer sociodemographic factors were associated with reduced diabetes control (PRD:-1.23, 95%CI:-1.18,-1.29) with strongest results in the most rural counties (PRD:-1.46, 95%CI:-1.36,-1.56). Decreasing quality in built environment domain was associated with decreasing prevalence rates of dia-betes control for all counties and urban-rural strata. Overall environmental quality exerts effects on diabetes control that vary across the rural-urban spectrum; in contrast, poor sociodemographic and built environmental factors impact diabetes control nationally. This abstract does not reflect EPA policy.