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Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes

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Abstract

BACKGROUND

Few studies have explored the association between neighborhood characteristics and adherence to diabetes self-management behaviors, and none have examined the influence of neighborhood safety on adherence to treatment regimens among patients with diabetes.

OBJECTIVE

To assess whether neighborhood safety is associated with self-reports of technical quality of care and with nonadherence to diabetes treatment regimens.

DESIGN

A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression models were used to examine the association of self-reported neighborhood safety with technical quality of care and treatment nonadherence, adjusted for sociodemographic characteristics, barriers to access to care, and health status.

PARTICIPANTS

Adults with type 2 diabetes currently receiving medical treatment.

MAIN MEASURES

Patient-reported neighborhood safety, performance of recommended processes of care by provider, treatment nonadherence (patient delays in filling prescriptions and obtaining needed medical care).

KEY RESULTS

Self-reported neighborhood safety was not associated with process measures of technical quality of care, but was associated with treatment nonadherence. Specifically, compared to those who report living in a safe neighborhood, a higher proportion of patients living in unsafe neighborhoods reported delays in filling a prescription for any reason (21.9% vs. 12.8%, aOR = 1.69, 95%CI 1.19, 2.40) and delays in filling a prescription due to cost (12.2% vs. 6.8%, aOR = 1.63, 95%CI 1.02, 2.62).

CONCLUSIONS

Contextual factors, such as neighborhood safety, may contribute to treatment nonadherence in daily life, even when the technical quality of care delivered in the clinic is not diminished.

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Acknowledgements

This work was supported by the National Institute of Diabetes, Digestive and Kidney Diseases (R18DK69846 and K01DK078939).

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Health Policy Research Institute, Department of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697-5800, USA

    John Billimek PhD & Dara H. Sorkin PhD

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  1. John Billimek PhD
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  2. Dara H. Sorkin PhD
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Correspondence to John Billimek PhD.

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Billimek, J., Sorkin, D.H. Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes. J GEN INTERN MED 27, 292–296 (2012). https://doi.org/10.1007/s11606-011-1882-7

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  • DOI: https://doi.org/10.1007/s11606-011-1882-7

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