Table 4.
Associations of Racial Residential Segregation and Racial Discrimination with Dichotomous Measures of Diabetes Management After Diagnosis1,2,3
| OR for Meeting Management Target (95% CI) | |||||
| Outcome | Segregation Category | Model 1 | Model 2 | Model 3 | Model 4 |
| HbA1c controlled (<7.0%) | High | Reference | Reference | Reference | Reference |
| Medium | 0.82 (0.44, 1.53) | 0.84 (0.41, 1.74) | 0.85 (0.40, 1.81) | 1.29 (0.59, 2.81) | |
| Low | 0.59 (0.31, 1.14) | 0.49 (0.25, 0.97) | 0.50 (0.25, 1.00) | 0.87 (0.37, 2.08) | |
| SBP controlled (<130 mm Hg) | High | Reference | Reference | Reference | Reference |
| Medium | 0.99 (0.50, 1.96) | 1.03 (0.50, 2.13) | 1.10 (0.55, 2.21) | 1.16 (0.54, 2.47) | |
| Low | 1.20 (0.58, 2.50) | 1.07 (0.50, 2.31) | 1.01 (0.44, 2.34) | 1.15 (0.42, 3.14) | |
| LDL controlled (<100 mg/dL) | High | Reference | Reference | Reference | Reference |
| Medium | 1.10 (0.63, 1.91) | 0.96 (0.54, 1.71) | 1.00 (0.56, 1.78) | 0.91 (0.50, 1.63) | |
| Low | 1.15 (0.65, 2.04) | 1.14 (0.63, 2.07) | 1.12 (0.59, 2.13) | 1.02 (0.48, 2.13) | |
| All 3 controlled | High | Reference | Reference | Reference | Reference |
| Medium | 1.19 (0.59, 2.41) | 1.34 (0.65, 2.78) | 1.38 (0.65, 2.94) | 1.51 (0.66. 3.45) | |
| Low | 0.73 (0.32, 1.63) | 0.57 (0.25, 1.28) | 0.61 (0.27, 1.38) | 0.68 (0.25, 1.84) | |
| OR for Meeting Management Target (95% CI) | |||||
| Outcome | Racial Discrimination Category | Model 1 | Model 2 | Model 3 | Model 4 |
| HbA1c controlled (<7.0%) | No Experiences | Reference | Reference | Reference | Reference |
| 1–2 Experiences | 0.97 (0.54, 1.74) | 0.95 (0.48, 1.86) | 0.96 (0.48, 1.95) | 0.93 (0.45, 1.93) | |
| 3+ Experiences | 0.98 (0.55, 1.76) | 0.91 (0.46, 1.78) | 0.95 (0.48, 1.88) | 0.90 (0.43, 1.87) | |
| SBP controlled (<130 mm Hg) | No Experiences | Reference | Reference | Reference | Reference |
| 1–2 Experiences | 0.71 (0.36, 1.37) | 0.69 (0.33, 1.42) | 0.60 (0.29, 1.28) | 0.59 (0.28, 1.26) | |
| 3+ Experiences | 1.12 (0.57, 2.18) | 1.24 (0.59, 2.61) | 1.15 (0.53, 2.50) | 1.12 (0.51, 2.43) | |
| LDL controlled (<100 mg/dL) | No Experiences | Reference | Reference | Reference | Reference |
| 1–2 Experiences | 1.02 (0.58, 1.79) | 1.14 (0.63, 2.07) | 1.13 (0.61, 2.07) | 1.09 (0.58, 2.05) | |
| 3+ Experiences | 1.35 (0.75, 2.45) | 1.52 (0.79, 2.91) | 1.58 (0.81, 3.05) | 1.53 (0.79, 2.98) | |
| All 3 controlled | No Experiences | Reference | Reference | Reference | Reference |
| 1–2 Experiences | 1.04 (0.45, 2.42) | 1.04 (0.42, 2.57) | 1.03 (0.40, 2.62) | 1.00 (0.39, 2.58) | |
| 3+ Experiences | 1.11 (0.53, 2.30) | 1.02 (0.46, 2.26) | 1.01 (0.44, 2.28) | 0.98 (0.43, 2.25) | |
OR: odds ratio; SBP: systolic blood pressure; LDL: low density lipoprotein cholesterol
Racial residential segregation categorized into high, medium, and low use the value of the local Gi* statistic, which measures the deviation of the census tract’s racial composition from that of the larger metropolitan area. A Gi* statistic z-score <0 was categorized as low, 0 to 1.96 as medium, and >1.96 as high segregation. Segregation category was treated as time-varying in these models.
Racial discrimination was assessed via survey. Participants reported whether they had experienced discrimination in any of 7 domains (e.g. school, getting a job, work, getting housing, getting medical care, on the street or in a public setting, from the police or in the courts). Discrimination was categorized as no experiences, 1–2 experiences, or 3+ experiences. Discrimination was treated as time-varying in these models.
Results are from generalized estimating equations (GEE) logistic regression models with an exchangeable covariance structure, accounting for clustering by participant across 2 exams (year 20 and year 25). Models included participant exam-years after diabetes development at which participants indicated a medical professional had diagnosed them with diabetes (n=305 exam-years total from 208 participants). Model 1 was unadjusted. Model 2 adjusted for baseline age, sex, field center, parental history of diabetes, time-varying education, marital status, diabetes duration, and use of diabetes medication, antihypertensive medication, and cholesterol-lowering medication. Model 3 additionally adjusted for time-varying smoking status, alcohol use, physical activity, diet score, waist circumference, and depressive symptoms. Model 4 additionally adjusted for census tract poverty and population density.