What do self-reported social risk and community-level social contextual factors tell us about diabetes self-management?

Abstract

Context: Higher exposure to social risks, such as food and housing insecurity are linked to worse outcomes for people with type 2 diabetes (T2DM). Social risks can be assessed at the individual-level (self-report of personal experience) and in aggregate at the community level (e.g. census data). What is less understood is how self-reported vs. community level information compare to one another, and which is most relevant for understanding individuals’ T2DM management. Objective: To exam ine the degree of overlap between self-reported social risk (SRSR) and community social contextual factors (CSCF), and document to what extent each is associated with T2DM management. Study Design: Cross-sectional survey geocoded and linked to publicly available data on CSCF. Setting: 12 community health centers in the San Francisco Bay Area. Population: 668 adults with T2DM. Measures: SRSR was assessed through four binary (yes/no) items related to housing instability, food insecurity, access to transportation, and difficulties paying bills. CSCF was assessed by the California Healthy Places Index (HPI), a measure that combines 25 community characteristics from five domains (neighborhood and built environment, health/health care, social/community context, education, economic stability) into a single indexed percentile score (0-100%). T2DM management outcomes included HbA1c from medical records, self-reported missed medication days and depression symptoms (PHQ8). Results: 38.2% (n=252) of our sample endorsed ≥ 1 SRSR. HPI quartiles yielded the following distribution: Q1=31.7% (n=211); Q2=30.3% (n=202); Q3=24.0% (n=160); Q4=14.0% (n=93). 10.4% of individuals in Q4 endorsed ≥1 SRSR (vs. 34.7% in Q1).