Research article
Neighborhood Socioeconomic Status, Depression, and Health Status in the Look AHEAD (Action for Health in Diabetes) Study
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* Corresponding author: Tiffany L Gary-Webb tlg2124@columbia.edu
1 Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3 Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
4 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
5 Division of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
6 Department of Medicine, St. Luke's--Roosevelt Hospital Center, New York, NY, USA
7 Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
8 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
BMC Public Health 2011, 11:349 doi:10.1186/1471-2458-11-349
Published: 19 May 2011Abstract
Background
Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression.
Methods
Individual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (% living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES.
Results
Overall, the % living in poverty in the participants' neighborhoods varied, mean = 11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (β-coefficient [β] = -1.90 units, 95% CI: -3.40,-0.039), mental health (β = -2.92 units, -4.31,-1.53) and global health (β = -2.77 units, -4.21,-1.33) composite scores.
Conclusion
In this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.