Association Between Social Determinants of Health and Glycemic Control Among African American People with Type 2 diabetes: The Jackson Heart Study

Jie Hu; David M Kline; Alai Tan; Songzhu Zhao; Guy Brock; Lorraine C Mion; Jimmy T Efird; Danxin Wang; Mario Sims; Bei Wu; Morgana Mongraw-Chaffin; Joshua J Joseph

doi:10.1093/abm/kaac026

Association Between Social Determinants of Health and Glycemic Control Among African American People with Type 2 diabetes: The Jackson Heart Study

Ann Behav Med. 2022 Nov 18;56(12):1300-1311. doi: 10.1093/abm/kaac026.

Authors

Jie Hu¹, David M Kline^{2

3}, Alai Tan¹, Songzhu Zhao³, Guy Brock³, Lorraine C Mion¹, Jimmy T Efird^{4

5}, Danxin Wang⁶, Mario Sims⁷, Bei Wu⁸, Morgana Mongraw-Chaffin⁹, Joshua J Joseph¹⁰

Affiliations

¹ College of Nursing, The Ohio State University, Columbus, OH, USA.
² Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
³ Center for Biostatistics, College of Medicine Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA.
⁴ Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
⁵ Boston VA Cooperative Studies Program Coordinating Center, Boston, MS, USA.
⁶ Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁷ University of Mississippi Medical Center, Jackson, MS, USA.
⁸ Rory Meyers College of Nursing, New York University, New York, NY, USA.
⁹ School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
¹⁰ College of Medicine, The Ohio State University, Columbus, OH, USA.

Abstract

Background: Social determinants of health have a significant impact on health outcomes. However, the complexity and interaction of multiple factors influencing glycemic control remain understudied.

Purpose: This study examined associations of socioeconomic position (income, education, and occupation), environmental (physical activity facilities, neighborhood social cohesion, neighborhood problem, and violence), behavioral (physical activity, nutrition, and smoking), and psychological factors (depressive symptoms, stress, and discrimination) with glycemic control (hemoglobin A1c [A1c]) using the World Health Organization Social Determinants of Health framework in African American adults with type 2 diabetes.

Methods: A secondary data analysis was conducted using a longitudinal cohort of 1,240 African American adults with type 2 diabetes who participated in the community-based Jackson Heart Study. Socioeconomic position, environmental, behavioral, and psychological factors were measured using validated instruments in the Jackson Heart Study. Longitudinal structural equation modeling was used with glycemic control (A1c) collected over time (Exams 1-3) as the study outcome.

Results: Our study presents the complex interplay of socioeconomic determinants of health and glycemic control over time. Higher socioeconomic position (higher income, higher level of education, and professional occupation) was directly associated with improvement in glycemic control over time. An association of socioeconomic position on glycemic control mediated through health behavior factors was also observed.

Conclusions: In this analysis, socioeconomic position components were determinants of glycemic control in African American adults with type 2 diabetes. Future studies aimed at reducing health disparities and achieving equality of outcomes in this population will benefit from embedding socioeconomic position components into their design.

Keywords: African Americans; Glycemic control; Jackson Heart Study; Social determinants of health; Type 2 diabetes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Black or African American* / psychology
Diabetes Mellitus, Type 2*
Glycated Hemoglobin
Glycemic Control
Humans
Longitudinal Studies
Social Determinants of Health

Substances

Glycated Hemoglobin A

Abstract

Publication types

MeSH terms

Substances

Grants and funding