Neighborhood socioeconomic disadvantage and travel time to diabetes prevention programs in Maryland

Abstract

Background

Transportation issues are a significant barrier for accessing the National Diabetes Prevention Program (NDPP), which remains an effective intervention to prevent type 2 diabetes. Although the link between neighborhood socioeconomic disadvantage and access to health care resources has been widely studied, its impact on travel time and access to NDPP has been underexplored.

Methods

Medicaid and private claims data for 2019 from the Maryland Medical Care Data Base were linked to 2019 Social Deprivation Index (SDI) data to measure neighborhood socioeconomic disadvantage. Google Distance Matrix Application Programming Interface key for Google Maps Platform was used to generate travel time estimates for enrollees diagnosed with prediabetes. Then adjusted generalized linear regression models using SDI quintiles and the interaction of SDI quintile and race and ethnicity were fitted to predict driving and public transit travel time to the nearest NDPP.

Findings

Enrollees living in neighborhoods with the highest SDI scores (most disadvantaged) had significantly shorter driving and public transit travel time to the nearest NDPP compared to enrollees living in neighborhoods with the lowest SDI scores (least disadvantaged). We found differences in the magnitude of shorter travel times across racial and ethnic groups and transportation mode.

Conclusion

Our findings fill a major gap in the literature on neighborhood socioeconomic disadvantage and travel time to NDPP. Findings highlight the role state policies may have had in expanding access to NDPP. More research is needed to examine strategies to address racial and ethnic disparities, and transportation needs to improve access to in-person NDPP.