Abstract：
BACKGROUND: The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.
METHODS: We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.
RESULTS: Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICEincome), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICErace) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICEcombined) had greater diabetes mortality.
CONCLUSIONS: Racial and economic segregation is associated with diabetes mortality across US counties.
METHODS: We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.
RESULTS: Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICEincome), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICErace) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICEcombined) had greater diabetes mortality.
CONCLUSIONS: Racial and economic segregation is associated with diabetes mortality across US counties.
摘要：
背景：这项研究的目的是研究2016年至2020年美国各县的种族和经济隔离与糖尿病死亡率之间的关系。
方法：我们进行了一项横断面生态学研究，该研究结合了来自国家生命统计系统的县级糖尿病死亡率数据和来自2016-2020年美国社区调查的社会人口统计学信息（n=2380个美国县）。种族化经济隔离是使用收入的极端集中度指数(ICE)(ICE收入)来衡量的，种族(ICErace)和综合收入和种族(ICEcombined)。ICE措施被分类为五分之一，Q1代表最高的集中度，Q5代表最低的低收入集中度，非西班牙裔(NH)黑人和低收入NH黑人家庭，分别。糖尿病被确定为死亡的根本原因。县级协变量包括65岁以上人群的百分比，大都市名称和人口规模。使用多水平泊松回归来估计比较Q1和Q5的调整平均死亡率和调整风险比(aRR)。
结果：调整后的平均糖尿病死亡率在低收入（ICE收入）和低收入NH黑人家庭（ICE合并）集中度较高的县持续较高。与浓度最低的县（Q1）相比，低收入集中度最高的县(Q5)(ARR1.93；ICE收入的95%CI1.79至2.09)，NH黑人（aRR1.93；ICErace的95％CI1.79至2.09）和低收入NH黑人家庭（aRR1.32；ICE合并的95％CI1.18至1.47）的糖尿病死亡率更高。
结论：种族和经济隔离与美国各县的糖尿病死亡率相关。
方法：我们进行了一项横断面生态学研究，该研究结合了来自国家生命统计系统的县级糖尿病死亡率数据和来自2016-2020年美国社区调查的社会人口统计学信息（n=2380个美国县）。种族化经济隔离是使用收入的极端集中度指数(ICE)(ICE收入)来衡量的，种族(ICErace)和综合收入和种族(ICEcombined)。ICE措施被分类为五分之一，Q1代表最高的集中度，Q5代表最低的低收入集中度，非西班牙裔(NH)黑人和低收入NH黑人家庭，分别。糖尿病被确定为死亡的根本原因。县级协变量包括65岁以上人群的百分比，大都市名称和人口规模。使用多水平泊松回归来估计比较Q1和Q5的调整平均死亡率和调整风险比(aRR)。
结果：调整后的平均糖尿病死亡率在低收入（ICE收入）和低收入NH黑人家庭（ICE合并）集中度较高的县持续较高。与浓度最低的县（Q1）相比，低收入集中度最高的县(Q5)(ARR1.93；ICE收入的95%CI1.79至2.09)，NH黑人（aRR1.93；ICErace的95％CI1.79至2.09）和低收入NH黑人家庭（aRR1.32；ICE合并的95％CI1.18至1.47）的糖尿病死亡率更高。
结论：种族和经济隔离与美国各县的糖尿病死亡率相关。
