Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jun 19, 2020
Date Accepted: Sep 8, 2020
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The Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network: Rationale, Protocol, and Baseline Characteristics
ABSTRACT
Background:
Diabetes prevalence and incidence vary by neighborhood socioeconomic environment (NSEE) and geographic region in the US. Identifying modifiable community factors driving type 2 diabetes disparities is essential to informing policy interventions that reduce the risk of type 2 diabetes.
Objective:
The Centers for Disease Control and Prevention established the Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network to apply harmonized epidemiologic approaches across unique and geographically expansive data to identify community factors that contribute to type 2 diabetes risk.
Methods:
The Diabetes LEAD Network is a collaboration of three study sites and a data coordinating center (Drexel University). The Geisinger/Johns Hopkins University study population includes 578,485 individuals receiving primary care at Geisinger, a health system serving a population representative of 37 counties in Pennsylvania. The New York University School of Medicine study population is a baseline cohort of 6,082,146 diabetes-free veterans receiving primary care through Veteran’s Affairs from every US county. The University of Alabama at Birmingham study population includes 11,199 participants diabetes-free at baseline, from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a cohort study with oversampling of participants from the Stroke Belt region.
Results:
The Network has established a shared set of aims: 1. Evaluate mediation in the association of NSEE with type 2 diabetes onset; 2. Evaluate effect modification in the association of NSEE with type 2 diabetes onset; 3. Assess the differential item functioning of community measures; and 4. Evaluate the impact of the spatial scale used to measure community factors. The Network has developed standardized approaches for measurement.
Conclusions:
The Network will provide insight into the community factors driving geographical disparities in type 2 diabetes risk. The Network will disseminate findings to stakeholders, providing guidance on policies to ameliorate geographic disparities in type 2 diabetes in the US.
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