American Journal of Epidemiology Advance Access originally published online on July 11, 2007
American Journal of Epidemiology 2007 166(4):379-387; doi:10.1093/aje/kwm190
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ORIGINAL CONTRIBUTIONS |
The Effect of Adverse Housing and Neighborhood Conditions on the Development of Diabetes Mellitus among Middle-aged African Americans
1 Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO
2 North Florida/South Georgia Veterans Health System, Gainesville, FL
3 Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL
4 Center for Research in the Implementation of Innovative Strategies in Practice, VA Iowa City Health Care System, Iowa City, IA
5 Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA
6 Department of Psychiatry, School of Medicine, St. Louis University, St. Louis, MO
7 Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
8 Department of Surgery, Washington University School of Medicine, St. Louis, MO
9 Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, IN
Correspondence to Dr. Mario Schootman, Division of Health Behavior Research, Washington University, 4444 Forest Park Boulevard, Box 8504, St. Louis, MO 63108 (e-mail: mschootm{at}im.wustl.edu).
Received for publication November 22, 2006. Accepted for publication February 8, 2007.
The authors examined the associations of observed neighborhood (block face) and housing conditions with the incidence of diabetes by using data from 644 subjects in the African-American Health Study (St. Louis area, Missouri). They also investigated five mediating pathways (health behavior, psychosocial, health status, access to medical care, and sociodemographic characteristics) if significant associations were identified. The external appearance of the block the subjects lived on and housing conditions were rated as excellent, good, fair, or poor. Subjects reported about neighborhood desirability. Self-reported diabetes was obtained at baseline and 3 years later. Of 644 subjects without self-reported diabetes, 10.3% reported having diabetes at the 3-year follow-up. Every housing condition rated as fair-poor was associated with an increased risk of diabetes, with odds ratios ranging from 2.53 (95% confidence interval: 1.47, 4.34 for physical condition inside the building) to 1.78 (95% confidence interval: 1.03, 3.07 for cleanliness inside the building) in unadjusted analyses. No association was found between any of the block face conditions or perceived neighborhood conditions and incident diabetes. The odds ratios for the five housing conditions were unaffected when adjusted for the mediating pathways. Poor housing conditions appear to be an independent contributor to the risk of incident diabetes in urban, middle-aged African Americans.
African Americans; aging; diabetes mellitus; housing; questionnaires; residence characteristics
Editor's note: An invited commentary on this article appears on page 388, and the authors' response is published on page 391.
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Related articles in Am. J. Epidemiol.:
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Am. J. Epidemiol. 2007 166: 388-390.[Abstract] [FREE Full Text] - Schootman et al. Respond to "Diabetes Causality in African Americans"
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Am. J. Epidemiol. 2007 166: 391-392.[Extract] [FREE Full Text]
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