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10.02.2020 | Original Research | Ausgabe 4/2020

Journal of General Internal Medicine 4/2020

Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 4/2020
Autoren:
PhD, MPH M. Maya McDoom, MD, MPH Lisa A. Cooper, PhD Yea-Jen Hsu, BA Abhay Singh, PhD Jamie Perin, MD, PhD Rachel L. J. Thornton
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-020-05671-y) contains supplementary material, which is available to authorized users.

Prior Presentations

An abstract of this article was presented at the AHA/EPI|Lifestyle Conference in New Orleans, LA, on March 20–23, 2018.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Background

Hypertension control and diabetes control are important for reducing cardiovascular disease burden. A growing body of research suggests an association between neighborhood environment and hypertension or diabetes control among patients engaged in clinical care.

Objective

To investigate whether neighborhood conditions (i.e., healthy food availability, socioeconomic status (SES), and crime) were associated with hypertension and diabetes control.

Design

Cross-sectional analyses using electronic medical record (EMR) data, U.S. Census data, and secondary data characterizing neighborhood food environments. Multivariate logistic regression analyses adjusted for potential confounders. Analyses were conducted in 2017.

Participants

Five thousand nine hundred seventy adults receiving primary care at three Baltimore City clinics in 2010–2011.

Main Measures

Census tract–level neighborhood healthy food availability, neighborhood SES, and neighborhood crime. Hypertension control defined as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Diabetes control defined as HgbA1c < 7.

Key Results

Among patients with hypertension, neighborhood conditions were not associated with lower odds of blood pressure control after accounting for patient and physician characteristics. However, among patients with diabetes, in fully adjusted models accounting for patient and physician characteristics, we found that patients residing in neighborhoods with low and moderate SES had reduced odds of diabetes control (OR = 0.74 (95% CI = 0.57–0.97) and OR = 0.75 (95% CI = 0.57–0.98), respectively) compared to those living in high-SES neighborhoods.

Conclusions

Neighborhood disadvantage may contribute to poor diabetes control among patients in clinical care. Community-based chronic disease care management strategies to improve diabetes control may be optimally effective if they also address neighborhood SES among patients engaged in care.

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