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Association between environmental quality and diabetes in the USA.

ABSTRACT: AIMS/INTRODUCTION:Caloric excess and physical inactivity fail to fully account for the rise of diabetes prevalence. Individual environmental pollutants can disrupt glucose homeostasis and promote metabolic dysfunction. However, the impact of cumulative exposures on diabetes risk is unknown. MATERIALS AND METHODS:The Environmental Quality Index, a county-level index composed of five domains, was developed to capture the multifactorial ambient environmental exposures. The Environmental Quality Index was linked to county-level annual age-adjusted population-based estimates of diabetes prevalence rates. Prevalence differences (PD, annual difference per 100,000 persons) and 95% confidence intervals (CI) were estimated using random intercept mixed effects linear regression models. Associations were assessed for overall environmental quality and domain-specific indices, and all analyses were stratified by four rural-urban strata. RESULTS:Comparing counties in the highest quintile/poorest environmental quality to those in the lowest quintile/best environmental quality, counties with poor environmental quality demonstrated lower total diabetes prevalence rates. Associations varied by rural-urban strata; overall better environmental quality was associated with lower total diabetes prevalence rates in the less urbanized and thinly populated strata. When considering all counties, good sociodemographic environments were associated with lower total diabetes prevalence rates (prevalence difference 2.77, 95% confidence interval 2.71-2.83), suggesting that counties with poor sociodemographic environments have an annual prevalence rate 2.77 per 100,000 persons higher than counties with good sociodemographic environments. CONCLUSIONS:Increasing attention has focused on environmental exposures as contributors to diabetes pathogenesis, and the present findings suggest that comprehensive approaches to diabetes prevention must include interventions to improve environmental quality.

SUBMITTER: Jagai JS

PROVIDER: S-EPMC7078099 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Association between environmental quality and diabetes in the USA.

Jagai Jyotsna S JS Krajewski Alison K AK Shaikh Sabina S Lobdell Danelle T DT Sargis Robert M RM

Journal of diabetes investigation 20191021 2

<h4>Aims/introduction</h4>Caloric excess and physical inactivity fail to fully account for the rise of diabetes prevalence. Individual environmental pollutants can disrupt glucose homeostasis and promote metabolic dysfunction. However, the impact of cumulative exposures on diabetes risk is unknown.<h4>Materials and methods</h4>The Environmental Quality Index, a county-level index composed of five domains, was developed to capture the multifactorial ambient environmental exposures. The Environmen ...[more]

PMID: 31579986

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Project description:Abstract Background and Aims Marital relationship and its quality are among the major psychological factors affecting the multiple aspects of a person's health status. Chronic diseases are also among the factors that affect various aspects of the lives of millions of people including their marital quality status. One of the most important underlying chronic diseases is diabetes. Since the correlation between diabetes mellitus and marital quality has been neglected, this systematic review, as the first one, aims to investigate the association between marital quality and diabetes mellitus. Methods A comprehensive search was conducted among three databases (Medline, Scopus, and Web of Science) until September 2021, which resulted in 189 articles. After assessing the studies based on the inclusion criteria, 14 studies were included. Results The included studies were divided into two general groups. The first group consisted of 3 articles examining the effect of factors related to diabetes on marital quality, and the second group included 11 articles studying the effect of marital quality on diabetes and its factors. In general, the articles investigating the impact of diabetes‐related factors on marital quality showed that diabetes has negative impacts on levels of marital quality. Also, the articles investigating the impact of marital quality on diabetes‐related factors, showed that higher marital quality is associated with a lower risk of developing diabetes, a better quality of life in patients with diabetes, and better adherence to diabetes care regimen. The results regarding diabetes management were conflicting. Gender was mentioned as an important modulator in some of the investigated relationships. Conclusion Marital quality remarkably influences diabetes‐related factors and is itself affected by the condition resulting from diabetes in individuals with diabetes mellitus. However, further studies are required due to the limited number of studies investigating this correlation.

Project description:ImportanceDiabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care.ObjectiveTo examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care.Design, setting, and participantsThis cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020.Main outcomes and measuresThe primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty.ResultsAmong the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas.Conclusions and relevanceThis cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.

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Association between environmental quality and diabetes in the USA.

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Association between environmental quality and diabetes in the USA.

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