Accessing Health: Examining Racial and Geographic Disparities in Diabetes Prevalence as a Result of the Built Environment

Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state. Keywords: Diabetes, Disparities, Access, Racial Segregation, Urban/Rural, Built Environment Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state