Spatial spillover and the socio-ecological determinants of diabetes-related mortality across US counties |
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| Institution: | 1. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA;2. Department of Kinesiology and Community Health, Division of Nutritional Sciences, University of Illinois-Urbana Champaign, Champaign, IL, USA;1. Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut;2. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut;3. Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut;4. Veterans Administration (VA) Connecticut Healthcare System, New Haven, Connecticut;1. Division of Mental Health and Well Being, University of Warwick, Coventry, UK;2. Bristol Royal Hospital for Children, Bristol, UK;3. School of Social and Community Medicine, St Michaels Hospital, Bristol, UK;4. Royal Victoria Infirmary, Newcastle upon Tyne, Tyneside, UK;5. Welsh Paediatric Palliative Medicine Network, Bangor University, Bangor, UK;6. University of Glamorgan Children''s Hospital, Cardiff, UK;1. Swiss Federal Office of Statistics, Neuchâtel, Switzerland;2. School of Physics, Trinity College Dublin, Ireland;3. Institute for Theoretical and High Energy Physics (LPTHE), University Pierre and Marie Curie, Paris, France;1. Faculty of Health, School of Medicine, Deakin Rural Health, Warrnambool, Victoria, Australia;2. Health Systems Improvement Unit, Centre for Population Health, School of Health and Social Development, Deakin University, VIC, Australia;3. Centre for Population Health Research, Deakin University, VIC, Australia;4. School of Psychological and Clinical Sciences, Charles Darwin University, NT, Australia;5. Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia;6. General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, VIC, Australia;7. Department of Medicine, Melbourne Medical School – Western Precinct, University of Melbourne, Sunshine Hospital, St Albans, VIC, Australia |
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| Abstract: | The spatial structure of diabetes-related mortality in US counties is evident from previous studies. However, it is not clear if spatial variation in diabetes-related mortality is associated with spatial variation in socioecological factors. We analyze the spatial spillover effect of changes in socioeconomic gradients (education, employment, household income), retail food environments, and access to health care, on diabetes-related mortality rates across the United States. Seven-year aggregates of multiple cause mortality data from the CDC WONDER compressed mortality database were merged with several sources of county-level data to examine mortality clusters, factors associated with the clusters, and spatial spillover effects in 3109 continuous US counties. The results suggest that high diabetes-related mortality cluster counties are located throughout the Southern Plains, Southeastern, and Appalachian regions. Lower socioeconomic status, a high density of fast food restaurants, a lack of access to grocery stores, a high proportion of Blacks, and low physical activity characterize high diabetes-related mortality rates clusters. The impacts from improvements in socioeconomic gradients and the retail food environment in neighboring counties spill over, and reduce the diabetes-related mortality rate in a particular county. This result implies that improvements in socioeconomic status and access to healthy food would significantly reduce diabetes-related mortality rates in contiguous US counties. |
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| Keywords: | Diabetes Mortality Socioeconomic gradients Built environment Social capital |
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