Association Between Neighborhood-Level Deprivation and Disability in a Community Sample of People With Diabetes
- Norbert Schmitz, PHD1,2,
- Danit Nitka, BA1,
- Genevieve Gariepy, MS1,
- Ashok Malla, MD1,
- JianLi Wang, PHD3,
- Richard Boyer, PHD4,
- Lyne Messier, MS5,
- Irene Strychar, EDD2,5 and
- Alain Lesage, MD4
- 1Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada;
- 2Montreal Diabetes Research Centre, Montreal, Quebec, Canada;
- 3Departments of Psychiatry and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada;
- 4Centre de Recherche Fernand Seguin, Hôpital Louis-H. Lafontaine, University of Montreal, Montreal, Quebec, Canada;
- 5Department of Nutrition, Faculty of Medicine, University of Montreal, and the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
- Corresponding author: Norbert Schmitz, norbert.schmitz{at}mcgill.ca.
Abstract
OBJECTIVE The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes.
RESEARCH DESIGN AND METHODS Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18–80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care–related problems, duration of diabetes, insulin use, and diabetes-specific complications.
RESULTS There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means ± SD disability scores for men were 7.8 ± 11.8, 12.0 ± 11.8, and 18.1 ± 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 ± 12.4, 14.8 ± 15.9, and 18.9 ± 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems.
CONCLUSIONS The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received May 6, 2009.
- Accepted August 3, 2009.
- © 2009 by the American Diabetes Association.
