Studies testing the effects of neighborhoods on the health of Black youth with T1D are limited. Racial residential segregation (RRS) is a form of structural racism that may affect health through various pathways, including limiting access to resources and increasing exposure to stress. The present study tested associations between RRS, diabetes management and glycemic control in a sample of 144 Black youth with T1D. Participants were recruited from seven pediatric clinics in two large US cities. Diabetes management was assessed by youth self-report using the Diabetes Management Scale (DMS) . RRS was calculated at the census block group level based on US census data using Location Quotient (LQ) s. LQs represented the ratio of Black to total population in the block group compared to the same ratio in the metro area. Mean youth age = 13.3 years (SD=1.7) , mean HbA1c = 11.5% (SD=2.7%) , mean family income = $34,163 (SD=$25,549) and mean LQ = 3. (SD=1.49) , indicating residence in highly segregated neighborhoods. In bivariate analyses, RRS was associated with HbA1c (r= .28, p= .001) but not DMS (r= -.08, p= .311) . Stepwise multiple regression was used to further test the effects of RRS on HbA1c. Covariates including youth age, insulin delivery method, and family income were entered on Step 1. RRS and a composite measure of neighborhood adversity were entered on Step 2. The R2 change on Step 2 was significant (p= .007) , indicating improved model fit. The final model accounted for 26% of the variance in HbA1c [F (5, 146) = 9.9, p= .001]. Only age (β= .23 p= .003) , insulin delivery method (β= -20 p= .01) and RRS (β= .18 p= .04) had significant effects on HbA1c. Results suggest that RRS had independent effects on glycemic control of Black youth with T1D even after controlling for effects of family income and neighborhood adversity. Findings are consistent with other studies demonstrating negative health consequences of structural racism; advocacy and policy-making to address such inequities could improve diabetes population health.
D.A. Ellis: None. A.I. Carcone: None. M.A. Evans: None. C.C. Boucher-Berry: None. J. Miller: Other Relationship; Element Bars, Inc. T. Drossos: None. M. Dekelbab: None. J.T. Rhind: None. J. Worley: None. C. Buggs-Saxton: Research Support; Boehringer Ingelheim International GmbH, National Institute of Diabetes and Digestive and Kidney Diseases.
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110075)