Objective: To determine whether community-level adverse social determinants of health are associated with increased risk of pregestational and gestational diabetes (DM, GDM).
Methods: We conducted a secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. We evaluated three community-level exposures using home addresses geocoded at the census-tract level: 1) socioeconomic disadvantage by 2015 Area Deprivation Index (ADI); 2) food insecurity by USDA Food Access Research Atlas; and 3) walkability by EPA National Walkability Score. The outcomes were DM and GDM.
Results: Of 9,155 assessed individuals, 33.6% were in the highest tertile (T3) of ADI, 24.4% lived in a food-insecure community, and 33.7% lived in a less walkable neighborhood; 1.5% (n=137) had DM and 4.2% (n=380) developed GDM. Individuals living in a community in the highest tertile of ADI were more likely to have DM (aOR: 2.49; 95% CI: 1.48, 4.18) and GDM (aOR: 1.49; 95% CI: 1.13, 1.97). Individuals living in a food-insecure community (aOR: 1.49; 95% CI: 1.17, 1.89) and living in a less walkable neighborhood (aOR: 1.29; 95% CI: 1.03, 1.62) were more likely to have GDM, but not DM.
Conclusions: Multiple measures of community-level adverse social determinants of health were associated with an increased risk of developing GDM. Only socioeconomic disadvantage was associated with DM.
C.P.Field: None. W.Grobman: None. J.Wu: None. C.Lynch: None. K.K.Venkatesh: None.
Eunice Kennedy Shriver National Institute of Child Health and Human Development
