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The association between environmental quality and uncontrolled diabetes among older adults in the U.S.
Citation:
Gray, C., S. Deflorio-Barker, L. Neas, L. Messer, K. Rappazzo, J. Jagai, M. Jimenez, A. Patel, AND D. Lobdell. The association between environmental quality and uncontrolled diabetes among older adults in the U.S. Society for Epidemiologic Research Annual Meeting, Seattle, Washington, June 20 - 23, 2017.
Impact/Purpose:
Investigation of associations between uncontrolled diabetes (diabetes hospitalizations) and environmental quality via the environmental quality index.
Description:
From 1990 to 2014, the diagnosed diabetes rate in the U.S. rose 111% among adults 65-74 and 140% among adults 75 or older. Recent studies have suggested factors such as air quality, neighborhood characteristics, and the social environment are associated with diabetes in older adults. Yet, no study has examined how multiple environmental domains simultaneously contribute to diabetes prevalence in older adults. We linked county counts of uncontrolled diabetes (diabetes hospitalizations) from 2010 Medicare hospitalization data (International Classification of Disease codes 250.00, 250.02) to 2010 population estimates from U.S. Census to calculate county-level prevalence of uncontrolled diabetes among U.S. adults 65 or older. We used the county-level Environmental Quality Index, a composite measure of 5 environmental domains (air, water, land, built and sociodemographic) and associated domain-specific indices to examine associations between environmental quality and county-level uncontrolled diabetes. Using fixed slope, random intercept linear regression models, clustered by state, and controlling for county percent minority, we report prevalence differences (PD) and 95% confidence intervals (CI). Comparing the worst environmental quality quintile to the best, we observed a decrease in uncontrolled diabetes (PD: -.06%; 95% CI: -.08, -.04). Using domain-specific indices, the worst quality quintile compared to the best was associated with increases in uncontrolled diabetes in the air domain (PD: .06%; 95% CI: .03, .09) and built domain (PD: .04%; 95% CI: .02, .06), but decreased uncontrolled diabetes in the water (PD: -.04%; 95% CI: -.07, 0.00 ), land (PD: -.02%; 95% CI: -.04, .01) ), and sociodemographic (PD: -.15%; 95% CI: -.18, -.12) domains. Environmental quality may play a role in uncontrolled diabetes among older adults, but the direction of estimates differs depending on the environmental domain. This abstract does not necessarily reflect EPA policy.