The role of neighbourhood environments in hospitalization risk for diabetes and related conditions: A population-based cohort analysis by remoteness and deprivation indices.

IF 2.7 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Health Reports Pub Date : 2022-12-21 DOI:10.25318/82-003-x202201200001-eng

Neeru Gupta, Dan Lawson Crouse, Pablo Miah, Tim Takaro

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引用次数: 0

Abstract

Background: Most socio-epidemiological studies on diabetes incidence, prevalence, or hospitalization focus on individual-level risk factors. This population-based cohort study sought to advance understanding on the associations of contextual characteristics and risk of diabetes-related avoidable hospitalization (DRAH) among at-risk Canadians.

Data and methods: A national cohort was compiled from the 2013/2014 Canadian Community Health Survey, representing 5.1 million adults aged 35 years and older, reporting having been diagnosed with diabetes, hypertension, or heart disease. Their information was linked longitudinally to hospitalization data from the 2013/14 to 2017/18 Discharge Abstract Database as well as to measures of geographic variability from the Material and Social Deprivation Index and the Index of Remoteness. Cox regression models were used to examine associations between the contextual indices and first occurrence of a DRAH.

Results: Residents in the most rural and remote communities were 50% more likely (hazard ratio (HR): 1.51, 95% confidence interval (95% CI): 1.26 to 1.80) to experience a DRAH than those in the most urbanized and accessible communities, and residents in the most socially deprived areas were significantly more likely (HR: 1.44, 95% CI: 1.26 to 1.65) to be hospitalized than those in the most socially privileged areas, controlling for individuals' sociodemographic characteristics and health behaviours. Neighbourhood material deprivation did not exercise a statistically significant influence on hospitalization risk after adjusting for the other residential characteristics.

Interpretation: There is a clear and significant gradient in diabetes-related hospitalization risk among Canadians with an underlying cardiometabolic condition by degree of residential remoteness and of neighbourhood social deprivation, independently of individual characteristics and despite Canada's universal healthcare system.

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社区环境在糖尿病及相关疾病住院风险中的作用:基于偏远和剥夺指数的人群队列分析

背景:大多数关于糖尿病发病率、患病率或住院率的社会流行病学研究集中于个体水平的危险因素。这项以人群为基础的队列研究旨在进一步了解高危加拿大人糖尿病相关可避免住院(DRAH)的背景特征和风险之间的关系。数据和方法:从2013/2014年加拿大社区健康调查中编制了一个国家队列，代表510万35岁及以上的成年人，报告被诊断患有糖尿病、高血压或心脏病。他们的信息与2013/14年至2017/18年出院摘要数据库的住院数据以及物质和社会剥夺指数和偏远指数的地理变异性指标进行了纵向关联。Cox回归模型用于检查上下文指标与首次发生DRAH之间的关联。结果:大多数农村和偏远社区的居民比大多数城市化和无障碍社区的居民经历DRAH的可能性高50%(风险比(HR): 1.51, 95%置信区间(95% CI): 1.26至1.80)，而最社会贫困地区的居民更有可能(HR: 1.44, 95% CI: 1.44)。(1.26至1.65)，在控制了个人的社会人口特征和健康行为后，住院率高于社会最优越地区的患者。在调整了其他居住特征后，邻里物质剥夺对住院风险没有统计学上显著的影响。结论:在有潜在心脏代谢疾病的加拿大人中，与居住偏远程度和社区社会剥夺程度有关的糖尿病相关住院风险存在明显且显著的梯度，独立于个人特征，尽管加拿大有全民医疗保健系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Reports PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

4.00%

发文量

期刊介绍： Health Reports publishes original research on diverse topics related to understanding and improving the health of populations and the delivery of health care. We publish studies based on analyses of Canadian national/provincial representative surveys or Canadian national/provincial administrative databases, as well as results of international comparative health research. Health Reports encourages the sharing of methodological information among those engaged in the analysis of health surveys or administrative databases. Use of the most current data available is advised for all submissions.