Association Between Social Determinants of Health and Glycemic Control Among African American People with Type 2 diabetes: The Jackson Heart Study

作者：Jie Hu, David Kline, Alai Tan, Songzhu Zhao, Guy Brock, Lorraine C. Mion, Jimmy T. Efird, Daqing Wang, Mario Sims, Bei Wu, Morgana Mongraw‐Chaffin, Joshua J. Joseph · 发表于：Annals of Behavioral Medicine · 年份：2022 · DOI：10.1093/abm/kaac026 · 被引用次数：12 · 研究领域：Diabetes Management and Education、Diabetes, Cardiovascular Risks, and Lipoproteins、Health disparities and outcomes

BACKGROUND: Social determinants of health have a significant impact on health outcomes. However, the complexity and interaction of multiple factors influencing glycemic control remain understudied. PURPOSE: This study examined associations of socioeconomic position (income, education, and occupation), environmental (physical activity facilities, neighborhood social cohesion, neighborhood problem, and violence), behavioral (physical activity, nutrition, and smoking), and psychological factors (depressive symptoms, stress, and discrimination) with glycemic control (hemoglobin A1c [A1c]) using the World Health Organization Social Determinants of Health framework in African American adults with type 2 diabetes. METHODS: A secondary data analysis was conducted using a longitudinal cohort of 1,240 African American adults with type 2 diabetes who participated in the community-based Jackson Heart Study. Socioeconomic position, environmental, behavioral, and psychological factors were measured using validated instruments in the Jackson Heart Study. Longitudinal structural equation modeling was used with glycemic control (A1c) collected over time (Exams 1-3) as the study outcome. RESULTS: Our study presents the complex interplay of socioeconomic determinants of health and glycemic control over time. Higher socioeconomic position (higher income, higher level of education, and professional occupation) was directly associated with improvement in glycemic control over time. An association ...