1421-P: Neighborhood Vulnerability and Diabetes Prevention Program Referrals in a Bronx Health System

Research on the determinants of Diabetes Prevention Programs (DPP) referral typically focuses on individual-level factors like patient and provider characteristics, neglecting neighborhood context. We aim to examine neighborhood environment vulnerability as a factor influencing likelihood of referral to a health system DPP in the Bronx, NY.

NEVI is a neighborhood vulnerability index based on composite measures reflecting 4 primary neighborhood-level domains (demographic, economic, residential, and health status) measured at the census tract-level. High and low NEVI was determined by a median split (median=0.48; range: 0.19-0.58). This study used an observational cross-sectional design and recorded patient demographic, anthropometric, and DPP referral data from the electronic health records. Eligibility was based on hemoglobin A1c (HbA1c) between 5.7-6.4 and body mass index (BMI) ≥25 (​​kg/m2), a NYC residential address, and seen for a PCP visit between January 2018 and February 2020. The association between NEVI and DPP referral was examined using logistic regression, adjusted for age, sex, insurance type, preferred language, HbA1c (mg/dL), and BMI.

Of 9,319 eligible patients, 66% were female, 78% were Hispanic or non-Hispanic Black, and the mean age was 53 years (SD: 13.9 years). Of referred patients, approximately 18% (n=851) have a higher NEVI while 12% (n=542) have a lower NEVI (p=2.2e-16). In the adjusted analysis, higher odds of referral were observed for patients residing in high NEVI neighborhoods than low NEVI neighborhoods (OR=1.50, 95% CI, 1.28-1.65).

We show a 50% higher likelihood of DPP referral among patients who reside in a high-vulnerability neighborhood. The reasons contributing referrals to DPP are likely multifactoral, including individual patient characteristics and PCP characteristics (e.g. knowledge & discretion). Our study highlights the importance of neighborhood-level context as a potential factor influencing PCP referrals to DPP.