PDF(Pubmed)
Abstract：
UNASSIGNED: Risk of complications due to gestational diabetes mellitus is increasing in the U.S., particularly among individuals from racial minorities. Research has focused largely on clinical interventions to prevent complications, rarely on individuals\' residential environments. This retrospective cohort study aims to examine the association between individuals\' neighborhoods and complications of gestational diabetes mellitus.
UNASSIGNED: Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median.
UNASSIGNED: Bivariate analysis showed that the average percentage of adults earning <$35,000 was higher in neighborhoods where individuals with complications were living than in neighborhoods where individuals without complications were living (30.40%±12.05 vs 28.94%±11.71, p=0.0145). Individuals who lived in areas with ≥8.9% of residents aged >25 years with less than high school diploma had a higher likelihood of complications than those who lived in areas with <8.9% of such residents (33.43% vs 29.02%, p=0.0272). Individuals who lived in neighborhoods that had ≥1.8% of households receiving public assistance were more likely to have complications than those who lived in areas where <1.8% of households received public assistance (33.33% vs 28.97%, p=0.0287). Logistic regression revealed that the odds of deliveries with complications were 44% higher for individuals with obesity (OR=1.44; 95% CI=1.17, 1.77), 35% greater for individuals residing in neighborhoods with higher percentages of households living below the poverty level (OR=1.35; 95% CI=1.09, 1.66), and 28% lower for individuals from neighborhoods where a higher percentage of households had no vehicles available for transportation to work (OR=0.72; 95% CI=0.59, 0.89).
UNASSIGNED: Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus.
UNASSIGNED: Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median.
UNASSIGNED: Bivariate analysis showed that the average percentage of adults earning <$35,000 was higher in neighborhoods where individuals with complications were living than in neighborhoods where individuals without complications were living (30.40%±12.05 vs 28.94%±11.71, p=0.0145). Individuals who lived in areas with ≥8.9% of residents aged >25 years with less than high school diploma had a higher likelihood of complications than those who lived in areas with <8.9% of such residents (33.43% vs 29.02%, p=0.0272). Individuals who lived in neighborhoods that had ≥1.8% of households receiving public assistance were more likely to have complications than those who lived in areas where <1.8% of households received public assistance (33.33% vs 28.97%, p=0.0287). Logistic regression revealed that the odds of deliveries with complications were 44% higher for individuals with obesity (OR=1.44; 95% CI=1.17, 1.77), 35% greater for individuals residing in neighborhoods with higher percentages of households living below the poverty level (OR=1.35; 95% CI=1.09, 1.66), and 28% lower for individuals from neighborhoods where a higher percentage of households had no vehicles available for transportation to work (OR=0.72; 95% CI=0.59, 0.89).
UNASSIGNED: Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus.
摘要：
■在美国，妊娠糖尿病并发症的风险正在增加，特别是在少数族裔的个人中。研究主要集中在预防并发症的临床干预上，很少在个人居住环境中。这项回顾性队列研究旨在研究个体社区与妊娠期糖尿病并发症之间的关联。
■人口和临床数据是从电子健康记录中提取的，并与美国人口普查局的2,047人的美国社区调查数据相关联，这些人在2014-2018年有2,164例分娩。2021-2022年的数据分析使用Wilcoxon秩和检验和卡方检验进行双变量分析，并使用逻辑回归进行独立效应分析。模型中使用的所有基于人口普查区的变量均以中位数二分。
■双变量分析表明，在有并发症的社区中，收入<35,000美元的成年人的平均百分比高于没有并发症的社区（30.40％±12.05vs28.94％±11.71，p=0.0145）。居住在年龄>25岁且高中文凭以下的居民中≥8.9％的地区的人比居住在此类居民中<8.9％的地区的人发生并发症的可能性更高（33.43％vs29.02％，p=0.0272)。居住在≥1.8％的家庭接受公共援助的社区中的个人比居住在<1.8％的家庭接受公共援助的地区的个人更容易出现并发症（33.33％vs28.97％，p=0.0287)。Logistic回归显示，肥胖患者发生并发症的几率高出44%（OR=1.44；95%CI=1.17，1.77）。居住在贫困线以下家庭百分比较高的社区中的个人增加了35％（OR=1.35；95％CI=1.09，1.66），对于来自较高比例的家庭没有可用于交通上班的车辆的社区的个人，则降低了28％（OR=0.72；95％CI=0.59，0.89）。
■与环境变化配合的临床干预可能有助于预防妊娠期糖尿病的母婴并发症。
■人口和临床数据是从电子健康记录中提取的，并与美国人口普查局的2,047人的美国社区调查数据相关联，这些人在2014-2018年有2,164例分娩。2021-2022年的数据分析使用Wilcoxon秩和检验和卡方检验进行双变量分析，并使用逻辑回归进行独立效应分析。模型中使用的所有基于人口普查区的变量均以中位数二分。
■双变量分析表明，在有并发症的社区中，收入<35,000美元的成年人的平均百分比高于没有并发症的社区（30.40％±12.05vs28.94％±11.71，p=0.0145）。居住在年龄>25岁且高中文凭以下的居民中≥8.9％的地区的人比居住在此类居民中<8.9％的地区的人发生并发症的可能性更高（33.43％vs29.02％，p=0.0272)。居住在≥1.8％的家庭接受公共援助的社区中的个人比居住在<1.8％的家庭接受公共援助的地区的个人更容易出现并发症（33.33％vs28.97％，p=0.0287)。Logistic回归显示，肥胖患者发生并发症的几率高出44%（OR=1.44；95%CI=1.17，1.77）。居住在贫困线以下家庭百分比较高的社区中的个人增加了35％（OR=1.35；95％CI=1.09，1.66），对于来自较高比例的家庭没有可用于交通上班的车辆的社区的个人，则降低了28％（OR=0.72；95％CI=0.59，0.89）。
■与环境变化配合的临床干预可能有助于预防妊娠期糖尿病的母婴并发症。
