期刊
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷 178, 期 2, 页码 221-230出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kws466
关键词
diabetes mellitus; lifestyle; multilevel analysis; residence characteristics; socioeconomic factors; type 2 diabetes
资金
- Competence Network Diabetes Mellitus of the German Federal Ministry of Education and Research [01GI0814]
- German Federal Ministry of Education and Research [01ZZ0403]
- German Ministry for Education, Research, and Cultural Affairs
- Ministry forSocial Affairs of the Federal State of Mecklenburg-West Pomerania
- Deutsche Forschungsgemeinschaft at the Martin Luther University of Halle-Wittenberg
- Wilhelm Roux Program of the Martin Luther University of Halle-Wittenberg
- Ministry of Education and Cultural Affairs of Saxony-Anhalt
- German Federal Employment Agency
- German Migraine and Headache Society
- Astra Zeneca, PLC
- Berlin-Chemie, AG
- Boots Healthcare International
- GlaxoSmithKline, PLC
- McNeil Pharma
- MSD Sharp Dohme GmbH
- Pfizer, Inc.
- Helmholtz Zentrum Munchen (German Research Center for Environmental Health)
- German Federal Ministry of Education and Research
- State of Bavaria
- German Research Foundation from the German Diabetes Center
- German Federal Ministry of Health
- Ministry of School, Science, and Research of the State of North Rhine-Westphalia
The objective of this study was to investigate the association between residential environment and type 2 diabetes. We pooled cross-sectional data from 5 population-based German studies (1997-2006): the Cardiovascular Disease, Living and Ageing in Halle Study, the Dortmund Health Study, the Heinz Nixdorf Recall Study, the Cooperative Health Research in the Region of Augsburg Study, and the Study of Health in Pomerania. The outcome of interest was the presence of self-reported type 2 diabetes. We conducted mixed logistic regression models in a hierarchical data set with 8,879 individuals aged 45-74 years on level 1; 226 neighborhoods on level 2; and 5 study regions on level 3. The analyses were adjusted for age, sex, social class, and employment status. The odds ratio for type 2 diabetes was highest in eastern Germany (odds ratio = 1.98, 95% confidence interval: 1.81, 2.14) and northeastern Germany (odds ratio = 1.58, 95% confidence interval: 1.40, 1.77) and lowest in southern Germany (reference) after adjustment for individual variables. Neighborhood unemployment rates explained a large proportion of regional differences. Individuals residing in neighborhoods with high unemployment rates had elevated odds of type 2 diabetes (odds ratio = 1.62, 95% confidence interval: 1.25, 2.09). The diverging levels of unemployment in neighborhoods and regions are an independent source of disparities in type 2 diabetes.
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