Diabetes is a complex chronic disease with many causes, complications and management needs. It affects a large proportion of people of varying ages, income levels, races/ethnicities and geographic areas. Approximately 7.0% of Pennsylvanians have been diagnosed with diabetes. Diabetes is a major public health challenge due to the enormous impact on the affected individual, their families and the health care system. However, recent research has shown that diabetes related mortality and morbidity can be prevented or delayed by controlling risk factors. Certain environmental aspects play an important role in the prevention and treatment of chronic diseases such as diabetes. In order to provide the public health community with another tool to enhance our understanding of the factors that affect the numbers and types of diabetes cases in Pennsylvania, it is important that we undertake a project that will support the analysis of geographic in terms of associated risk factors.
This study proposed to investigate geographical patterns of diabetes hospitalizations, risk factors for diabetes complications and glycemic control among individuals with type 2 diabetes in rural regions. Residents of more rural counties are 11% more likely to be hospitalized for uncontrolled diabetes compared to those living in areas that are less rural for every increase in rurality ranking. Furthermore, we demonstrated that there is a clear association between the presence of food stores, food service places, and health care locations with risk factors for diabetes complications among individuals with diabetes. Our findings also indicated that those who live more than ten miles from their diabetes management center are 88% more likely to have an HbA1c level greater than 7.0% compared to those who live less than ten miles from their center, adjusted for individual-level and community level factors. Results demonstrated that for every mile the subjects live from their diabetes management center, they are 2% more likely to have an HbA1c level greater than 7.0%. These findings are of public health significance because they demostrate a clear association between the built envirnment and diabetes hospitalizations, risk factors for diabetes complications and glycemic control among individuals with diabetes in rural regions.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04082009-113915 |
| Date | 29 June 2009 |
| Creators | Bettencourt, Laura A. |
| Contributors | Ravi Sharma, Janice Zgibor, Hassan Karimi, Anthony Fabio, Evelyn Talbot |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04082009-113915/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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