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Assessing county-level determinants of diabetes in the United States (2003–2012)
Journal article   Open access   Peer reviewed

Assessing county-level determinants of diabetes in the United States (2003–2012)

Justin M. Feldman, David C. Lee, Priscilla Lopez, Pasquale E. Rummo, Annemarie G. Hirsch, April P. Carson, Leslie A. McClure, Brian Elbel and Lorna E. Thorpe
Health & place, v 63, 102324
May 2020
PMID: 32217279
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12965709/pdf/nihms-2136776.pdfView
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Abstract

Built environment Diabetes Multilevel modeling
Using data from the United States Behavioral Risk Factor Surveillance System (2003–2012; N = 3,397,124 adults), we estimated associations between prevalent diabetes and four county-level exposures (fast food restaurant density, convenience store density, unemployment, active commuting). All associations confirmed our a priori hypotheses in conventional multilevel analyses that pooled across years. In contrast, using a random-effects within-between model, we found weak, ambiguous evidence that within-county changes in exposures were associated with within-county change in odds of diabetes. Decomposition revealed that the pooled associations were largely driven by time-invariant, between-county factors that may be more susceptible to confounding versus within-county associations. •Multilevel analyses of repeated cross-sectional surveys depend on model choice.•4 county-level measures predicted diabetes in a model that ignored temporality.•There is marginal evidence that increasing walkability led to decreased diabetes.•No other findings were supported by a model that considered change over time.•Models of repeated-cross sectional survey data should incorporate temporality.

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5 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#10 Reduced Inequalities

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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