1. Community-level social determinants of health and pregestational and gestational diabetes.
- Author
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Field, Christine, Grobman, William, Yee, Lynn, Johnson, Jasmine, Wu, Jiqiang, McNeil, Becky, Mercer, Brian, Simhan, Hyagriv, Reddy, Uma, Silver, Robert, Parry, Samuel, Saade, George, Chung, Judith, Wapner, Ronald, Lynch, Courtney, and Venkatesh, Kartik
- Subjects
Area Deprivation Index ,food desert ,food insecurity ,gestational diabetes ,neighborhood disadvantage ,pregestational diabetes ,pregnancy ,social determinants of health ,walkability ,Pregnancy ,Female ,United States ,Humans ,Diabetes ,Gestational ,Social Determinants of Health ,Prospective Studies ,Residence Characteristics ,Pregnancy Outcome - Abstract
BACKGROUND: Individual adverse social determinants of health are associated with increased risk of diabetes in pregnancy, but the relative influence of neighborhood or community-level social determinants of health is unknown. OBJECTIVE: This study aimed to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. STUDY DESIGN: We conducted a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Home addresses in the first trimester were geocoded at the census tract level. The exposures (modeled separately) were the following 3 neighborhood-level measures of adverse social determinants of health: (1) socioeconomic disadvantage, defined by the Area Deprivation Index and measured in tertiles from the lowest tertile (ie, least disadvantage [T1]) to the highest (ie, most disadvantage [T3]); (2) food desert, defined by the United States Department of Agriculture Food Access Research Atlas (yes/no by low income and low access criteria); and (3) less walkability, defined by the Environmental Protection Agency National Walkability Index (most walkable score [15.26-20.0] vs less walkable score [
- Published
- 2024