Differences by race in the associations between neighborhood crime and violence and glycemic control among adults with type 2 diabetes

BACKGROUND: Limited data exist on the differential association between neighborhood characteristics such as crime and violence and diabetes outcomes by race. OBJECTIVE: To examine racial differences in the relationship between neighborhood characteristics (crime and violence) and glycemic control in a sample of adults with type 2 diabetes (T2DM). DESIGN: A cross-sectional study. PARTICIPANTS: 601 adults with T2DM from the Southeastern United States. MEASUREMENTS: Outcome was glycemic control. Neighborhood violence and crime were the primary independent variable, and previously validated scales and indices were used to assess neighborhood crime and violence. Covariates included age, gender, education, marital status, income, hours of work per week, duration of diabetes, comorbidity, health status, and site of recruitment. Multiple linear regression was used to assess the relationship between neighborhood characteristics (violence and crime) and glycemic control adjusting for relevant covariates. RESULTS: Approximately 66% of the sample population was Black with ages ranging between 49–71 years. The unadjusted mean hemoglobin A1c (HbA1c) was significantly higher for Black adults compared to White adults (8.0 ± 2.0 vs. 7.8 ± 1.6; p = 0.002). In the fully adjusted stratified model, glycemic control was significantly associated with neighborhood crime (β-coefficient: 0.36; 95% CI 0.07, 0.65) and neighborhood violence (β-coefficient: 0.14; 95% CI 0.003, 0.28) for White adults in the fully adjusted model; these relationships were not significant for Black adults. CONCLUSION: In this sample of adults with T2DM, neighborhood crime and violence were significantly associated with glycemic control for White adults, but not for Black adults. Additional research is needed to understand perceptions of neighborhood crime and violence between White adults and Black adults with T2DM.