Abstract P295: Residential Segregation Is Associated With Uncontrolled Diabetes Among Brazilian Adults: The Brazilian Longitudinal Study Of Adult Health (elsa-brasil)
Authors: Sharrelle Barber, Joanna Guimarães, Cardoso Leticia, Devlin Amie, Janeway Granche, Rosane Griep, Maria Fonseca, Maria Schmidt, Ana V Diez Roux, Dora Chor
Journal: Circulation (2020)

Introduction: The prevalence of type-2 diabetes is increasing globally with the sharpest increases occurring in low and middle-income countries. Residential segregation results in increased exposure to adverse neighborhood environments that may inhibit the successful management of diabetes. Moreover, due to historical and contemporary forms of structural racism, marginalized racial groups are more likely to live in these environments. Using a spatial measure of neighborhood-level economic residential segregation (hereafter, segregation) we examined the association between segregation and uncontrolled diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: The sample included 828 Black, Brown/Mixed-Race, and White participants ages 35-74 with diagnosed diabetes and complete, geocoded information from the baseline examination of ELSA-Brasil (2008-2010). Residential segregation was based on data from the 2010 IBGE demographic census and calculated for study-defined neighborhoods using the local G i * statistic— a spatially weighted z-score that represents how much a neighborhood’s income composition deviates from the larger metropolitan area. Uncontrolled diabetes was based on 2017 ADA criteria and defined as HbA1c ≥ 7%. Multivariable logistic regression models were used to test cross-sectional associations between segregation and uncontrolled diabetes. Results: Black and Brown participants were more likely than Whites to live in highly segregated neighborhoods. The prevalence of uncontrolled diabetes increased across low, medium, and high levels of segregation (23.1% vs. 37.8% vs. 47.7%, respectively). In multivariable models adjusting for age, gender, race, education, income, and study site, segregation was positively associated with uncontrolled diabetes (OR: 1.20, 95% CI: 1.07-1.56). The association was attenuated but remained statistically significant in models adjusting for neighborhood characteristics, behavioral risk factors and time since diabetes diagnosis. (OR: 1.16; 95% CI: 1.05-1.28). In models that included segregation as a categorical variable, individuals living in highly segregated neighborhoods had a 2-fold higher risk of uncontrolled diabetes compared to individuals living in less segregated neighborhoods (High Segregation, OR: 2.20, 95% CI: 1.35-3.58; Medium Segregation, OR: 1.65, 95% CI: 1.08-2.51). Conclusions: Residential segregation may lead to disparate diabetes-related morbidity among urban-dwelling adults in Brazil. Moreover, the disproportionate clustering of Blacks and Browns within segregated neighborhoods implicates segregation as a potential driver of racial inequalities in these outcomes. Policies and/or structural interventions designed to improve neighborhood conditions may be viable strategies to improve the management of diabetes in this setting.