Relative Contribution of Individual, Community, and Health System Factors on Glycemic Control Among Inner-City African Americans with Type 2 Diabetes. J Racial Ethn Health Disparities 2021 Apr;8(2):402-414
Date
06/27/2020Pubmed ID
32588396Pubmed Central ID
PMC7759592DOI
10.1007/s40615-020-00795-7Scopus ID
2-s2.0-85086855310 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: Health disparities disproportionately impact inner-city African Americans; however, limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes in this population.
METHODS: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A conceptual framework was used to specify measurements across the individual level, such as age and comorbidities; community level, such as neighborhood factors and support; and health system level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health system factors and regressed against HbA1c.
RESULTS: In the final adjusted model across all four approaches, individual-level factors like age (β = - 0.05; p < 0.001); having 1-3 comorbidities (β = - 2.03; p < 0.05), and having 4-9 comorbidities (β = - 2.49; p = 0.001) were associated with poorer glycemic control. Similarly, male sex (β = 0.58; p < 0.05), being married (β = 1.16; p = 0.001), and being overweight/obese (β = 1.25; p < 0.01) were associated with better glycemic control. Community and health system-level factors were not significantly associated with glycemic control.
CONCLUSION: Individual-level factors are key drivers of glycemic control among inner-city African Americans. These factors should be the key targets for interventions to improve glycemic control in this population. However, community and health system factors may have indirect pathways to glycemic control that should be examined in future studies.
Author List
Campbell JA, Yan A, Walker RE, Weinhardt L, Wang Y, Walker RJ, Egede LEAuthors
Jennifer Annette Campbell PhD, MPH Assistant Professor in the Medicine department at Medical College of WisconsinLeonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
Lance S. Weinhardt MS,PhD Associate Dean for Research and Professor of Community and Behavioral Health Promotion in the Joseph. J. Zilber School of Public Health department at University of Wisconsin - Milwaukee
MESH terms used to index this publication - Major topics in bold
AgedCities
Cross-Sectional Studies
Delivery of Health Care
Diabetes Mellitus, Type 2
Female
Humans
Male
Middle Aged
Residence Characteristics
Risk Factors
Wisconsin
