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Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records
Journal article   Open access   Peer reviewed

Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records

Félice Lê-Scherban, Lance Ballester, Juan C. Castro, Suzanne Cohen, Steven Melly, Kari Moore and James W. Buehler
Preventive medicine reports, v 15, 100953
Sep 2019
DOI: https://doi.org/10.1016/j.pmedr.2019.100953
PMID: 31367515
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.pmedr.2019.100953View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open

Abstract

African Americans Diabetes Electronic health records Hypertension Neighborhoods Social determinants of health
For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control (n = 1061 and n = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02–1.57] for diabetes, 1.22 [1.12–1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants. •African American patients in segregated communities have worse hypertension control.•African American patients in segregated communities have worse diabetes control.•African American patients in more walkable communities have better diabetes control.

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37 citations in Web of Science
36 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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Web of Science research areas
Public, Environmental & Occupational Health
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