Type 2 diabetics from lower SES groups have worse diabetes control, higher rates of complications, and higher mortality rates. Significant gaps remain in our understanding of the pathways by which SES affects diabetic outcomes. Low SES is consistently associated with a number of important social environmental disadvantages including poverty, crime, and poor housing. While several studies have found higher rates of complications among Type 2 diabetics living in socially disadvantaged communities, these studies have lacked detailed individual-level data.
In this application, the candidate proposes an innovative clinical population-based study to determine the effects of social environmental factors on diabetes control. The study employs a case-control design to assess the relationship between the social environment and diabetes control among veterans using the Philadelphia VAMC. The candidate hypothesizes that after adjusting for known risk factors for poor diabetes control (including individual SES), individuals living in disadvantaged social environments will have worse diabetes control. To evaluate this hypothesis the candidate will collect detailed individual-level data from subjects themselves, as well as their medical chart and link this to detailed neighborhood environmental data.
This pilot study will allow the candidate to refine and test the data collection instruments, develop the methodologies needed to evaluate individual and environmental data, and provide very important estimates for both the effect size and the degree of inter-correlation between individual SES and the social environmental. All of which are essential preliminary steps for a large scale study examining the