Cross-Sectional and Prospective Associations Between Neighborhood Socioeconomic Status and Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Background Diabetes is increasing in the United States, and affects almost a third of older adults. Previous research has focused on clinical and individual risk factors for diabetes, and there is little research on the contribution of the neighborhood environment to diabetes incidence and prevalence. Methods The Atherosclerosis Risk in Communities (ARIC) study enrolled 15,792 patients at four sites in the United States between 1987-89. Participants were followed for three additional study visits and annual telephone follow-up. Residential address at the first visit was linked to census tract. The primary exposure was a neighborhood socioeconomic summary score created from 6 census tract variables. The outcomes of interest were diabetes incidence and prevalence, measured by self-report and fasting plasma glucose. Multivariate logistic regression and Cox Proportional Hazards models stratified by race were used to evaluate the affect of neighborhood socioeconomic status on prevalence and incidence of diabetes. Results Among 11,032 white participants in the ARIC study, higher neighborhood socioeconomic status was associated with a statistically significant decrease in the prevalence of diabetes at the first ARIC study visit (OR for each unit increase in socioeconomic status 0.978, 95% CI 0.961-0.995) and with a statistically significant decrease in the incidence of diabetes over time (HR for each unit increase in socioeconomic status 0.972, 95% CI 0.962-0.982) after adjusting for age, sex, income and education. Among black participants, neighborhood socioeconomic status was not associated with prevalence of diabetes at baseline or incidence of diabetes across the study period. Conclusion This study is one of the first evaluations of the affect of neighborhood socioeconomic status and diabetes. Further studies are needed to explore the differential effects of neighborhood socioeconomic status by race