The Effect of Adverse Housing and Neighborhood Conditions on the Development of Diabetes Mellitus among Middle-aged African Americans

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
American Journal of Epidemiology (Impact Factor: 5.23). 09/2007; 166(4):379-87. DOI: 10.1093/aje/kwm190
Source: PubMed


The authors examined the associations of observed neighborhood (block face) and housing conditions with the incidence of diabetes by using data from 644 subjects in the African-American Health Study (St. Louis area, Missouri). They also investigated five mediating pathways (health behavior, psychosocial, health status, access to medical care, and sociodemographic characteristics) if significant associations were identified. The external appearance of the block the subjects lived on and housing conditions were rated as excellent, good, fair, or poor. Subjects reported about neighborhood desirability. Self-reported diabetes was obtained at baseline and 3 years later. Of 644 subjects without self-reported diabetes, 10.3% reported having diabetes at the 3-year follow-up. Every housing condition rated as fair-poor was associated with an increased risk of diabetes, with odds ratios ranging from 2.53 (95% confidence interval: 1.47, 4.34 for physical condition inside the building) to 1.78 (95% confidence interval: 1.03, 3.07 for cleanliness inside the building) in unadjusted analyses. No association was found between any of the block face conditions or perceived neighborhood conditions and incident diabetes. The odds ratios for the five housing conditions were unaffected when adjusted for the mediating pathways. Poor housing conditions appear to be an independent contributor to the risk of incident diabetes in urban, middle-aged African Americans.

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Available from: J. Philip Miller
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    • "Characteristics of local neighborhoods are now frequently incorporated into research assessing factors associated with health behaviors and outcomes [1-6]. Empirical studies arise from a number of theoretical frameworks, including an overarching public health socio-ecological framework [7] and more finely nuanced theories and conceptual frameworks regarding specific neighborhood characteristics and hypothesized outcomes such as walking and physical activity [8,9], obesity [10], disability and physical function [11-16], parenting [6], and specific health conditions such as depression [17,18], diabetes [19], and inflammatory markers [20]. Observer-rated measures for research on the effects of neighborhoods include a range of options related to research objectives, hypotheses, and theoretical models. "
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    ABSTRACT: Although neighborhood characteristics have important relationships with health outcomes, direct observation often involves imperfect measurement. The African American Health (AAH) study included two observer neighborhood rating systems (5-item Krause and 22-item AAH Neighborhood Assessment Scale [NAS]). Good measurement characteristics were previously shown for both, although there was more rater variability than desired. In 2010 both measures were re-fielded, hypothesizing that enhanced training and field methods would have decreased rater variability. AAH included a poor inner city and more heterogeneous suburban areas. Four interviewers rated 483 blocks, with 120 randomly selected blocks rated by two interviewers. We tested the Krause scale (5--20 points), AAH NAS with 22 items, plus a brief NAS (7-items; 0--17 points). Retest reliability for items (kappa) and scales (Intraclass Correlation Coefficient [ICC]) were calculated overall and among pre-specified subgroups. Linear regression assessed interviewer effects on total scale scores. Concurrent validity was examined using linear regression on lung and lower body functions, and self-rated health (SRH). The effect of mismeasurement on predicting self-rated health was assessed. Scale scores were lower (better) in the suburban area than in the inner city. ICC was poor for the Krause scale overall (ICC=0.19), but was better if the retests were within 10 days (ICC=0.49). The brief AAH NAS scale had a much better ICC (0.56) overall, and was even higher (0.71) within 10 days. Interviewers demonstrated strikingly different raw scores for both scales, with 1--3 point differences (compared to the supervising rater). Concurrent validity for health outcomes was modest, with residents living in worse neighborhood conditions demonstrating worse function and SRH. Unadjusted estimates were smaller (biased towards the null) compared with measurement-error corrected estimates. Enhanced field protocols and rater training that reduced the opportunity for interrater variability failed to fully eradicate prior measurement concerns. Specifically, retest reliability and interviewer variability remained problematic. The error effect reduced, but did not eliminate, expected findings in the validation analyses, suggesting there are robust associations between neighborhood characteristics and health outcomes. We urge additional examination of measurement properties of environmental rating methods and thorough discussion of field protocols and training.
    Full-text · Article · Oct 2013 · BMC Public Health
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    • "Additional questions probed reasons for relocations. This information will be used to determine the effects of the built environment and/or neighborhood conditions (such as nearby restaurants, grocery stores, green space, and yard and sidewalk quality) on cardiovascular and emotional health using geographic information system methods plus observational data from the parent study [78,101,102]. "
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    ABSTRACT: Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs.Methods/design: The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936--1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009--11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways. This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.
    Full-text · Article · Sep 2013 · BMC Cardiovascular Disorders
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    • "Nonetheless, the limited evidence suggests that supportive built environments are associated with favorable blood pressure levels or lower prevalence of hypertension [21-23]. Only two studies have investigated the influence of neighborhood resources or neighborhood housing conditions on type-2 diabetes mellitus [24,25], and there appears to be no studies examining associations between the built environment and hypercholesterolaemia or the metabolic syndrome [20]. "
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    ABSTRACT: Studies repeatedly highlight associations between the built environment and physical activity, particularly walking. Fewer studies have examined associations with cardiometabolic risk factors, with associations with obesity inconsistent and scarce evidence examining associations with other cardiometabolic risk factors. We aim to investigate the association between neighborhood walkability and the prevalence of obesity, hypertension, hypercholesterolaemia, and type-2 diabetes mellitus. Cross-sectional study of 5,970 adults in Western Australia. Walkability was measured objectively for a 1,600m and 800m neighborhood buffer. Logistic regression was used to assess associations overall and by sex, adjusting for socio-demographic factors. Mediation by physical activity and sedentary behavior was investigated. Individuals living in high compared with less walkable areas were less likely to be obese (1,600m OR: 0.84, 95%CI: 0.7 to 1; 800m OR: 0.75, 95%CI: 0.62 to 0.9) and had lower odds of type-2 diabetes mellitus at the 800m buffer (800m OR: 0.69, 95% CI: 0.51 to 0.93). There was little evidence for an association between walkability and hypertension or hypercholesterolaemia. The only significant evidence of any difference in the associations in men and women was a stronger association with type-2 diabetes mellitus at the 800m buffer in men. Associations with obesity and diabetes attenuated when additionally adjusting for physical activity and sedentary behavior but the overall association with obesity remained significant at the 800m buffer (800m OR: 0.78, 95%CI: 0.64 to 0.96). A protective association between neighborhood walkability and obesity was observed. Neighborhood walkability may also be protective of type-2 diabetes mellitus, particularly in men. No association with hypertension or hypercholesterolaemia was found. This warrants further investigation. Findings contribute towards the accumulating evidence that city planning and policy related strategies aimed at creating supportive environments could play an important role in the prevention of chronic diseases.
    Full-text · Article · Aug 2013 · BMC Public Health
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