Association between Social Determinants of Health and Glycemic Control in an Inner City Primary Care Population
Keywords:Social determinants of health, diabetes mellitus, type 2, Primary health care.
AbstractBackground: Diabetes is among the 10 leading causes of death in the U.S. Effective disease management comprised of medical care, self-management education, and ongoing diabetes support is key to improving quality of life and reducing acute and long-term complications. Evidence suggests that social determinants of health acting through social support, neighborhood quality, and physical activity influence diabetes prevention, management, and outcomes. The Chronic Illness Resource Survey (CIRS) is a reliable and valid instrument for assessing support and resources for chronic disease management and is based on a multi-level socio-environmental model. We conducted this study to assess the relationship between social resources as estimated by CIRS subscales and glycemic control in our urban safety-net clinic to identify specific types of support that are associated with glycemic control. Methods: Adult patients (n= 104) with a diagnosis of type 2 diabetes were recruited from an academic urban safety-net clinic in Buffalo, New York. Eligible patients were approached during a regularly scheduled clinic appointment while waiting for their provider. Average hemoglobin A1c values were compared between subjects with values above and below the median for each CIRS subscale. The age and BMI-adjusted relative risks for having a hemoglobin A1c value >7% were also estimated for each subscale. Results: In this sample having established medical care, lower neighborhood support was associated with elevated A1c (OR: 3.10, 95% CI 1.39 to 6.90). Social determinants related to support from family and friends, community organizations, personal factors, and media and policy were not associated with A1c. Exploration of individual items in the neighborhood support subscale suggested that social interaction with neighbors were particularly associated with diabetes control. Conclusions: A higher level of neighborhood support and greater interaction with neighbors in patients from an inner city primary care clinic was associated with better glycemic control. Future research will evaluate how neighborhood support influences self-management behaviors, and how self-management behavior may be modified by increased social interactions with neighbors.
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