Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study

Usama Bilal · Felicia Hill‐Briggs · Luis Sánchez Perruca · Isabel del Cura-González · Manuel Franco

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Health disparities and outcomes Diabetes, Cardiovascular Risks, and Lipoproteins Public Health and Social Inequalities

Abstract

OBJECTIVE: To study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain. SETTING: Electronic health records of the primary-care system in four districts of Madrid (Spain). PARTICIPANTS: 269 942 people aged 40 or older, followed from 2013 to 2014. EXPOSURE: Neighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions. PRIMARY OUTCOME MEASURES: Diagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %). RESULTS: In regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15). CONCLUSIONS: Diabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.

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References

2005Social determinants of health inequalities 2001Sick individuals and sick populations 2011Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment 2000Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas 2013Disparities in Diabetes: The Nexus of Race, Poverty, and Place 2015Socio-Economic Segregation in European Capital Cities 2015Longitudinal Associations Between Neighborhood Physical and Social Environments and Incident Type 2 Diabetes Mellitus 2009Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis.

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2019Socioeconomic status, life expectancy and mortality in a universal healthcare setting: An individual-level analysis of >6 million Catalan residents 2021Urban social determinants of non-communicable diseases risk factors in Argentina 2020Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain 2019Neighborhood social and economic change and diabetes incidence: The HeartHealthyHoods study

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