Neighborhood Environment and Longitudinal Follow-Up of Glycosylated Hemoglobin for Youth with Overweight or Obesity.

Abstract

Background: Neighborhood environment, which includes multiple social drivers of health, has been associated with a higher incidence of chronic conditions in adult cohorts. We examine if neighborhood environment is associated with glycosylated hemoglobin (HbA1c) and body mass index (BMI) as a percentage of the 95th percentile (BMIp95) for youth with overweight and obesity. Methods: Cohort study using electronic health record data from a large Midwestern Children's Hospital. Youth aged 8-16 years qualified for the study with a documented BMI ≥ 85th percentile and two HbA1c test results between January 1, 2017, and December 31, 2019. Neighborhood environment was measured using area deprivation index (ADI). Results: Of the 1,309 youth that met eligibility, mean age was 14.0 ± 3.2 years, 58% female, 48% Black, and 39% White. At baseline, the average (SD) of BMIp95 was 126.1 (26.14) and HbA1c5.4 (0.46). 670 (51%) lived in a more deprived (MD) area. The median time to follow-up was 15-months. Youth that lived in a MD area had a significantly higher follow-up HbA1c (β = 0.034, p = 0.03, 95% confidence interval [CI]: [0.00, 0.06]) and BMIp95 (β = 1.283, p = 0.03, 95% CI: [0.13, 2.44]). An increase in BMIp95 was associated with worse HbA1c for most youth that lived in a MD area. Conclusions: Youth that lived in an MD area had a small but statistically significant higher level of HbA1c and BMIp95 at follow-up. Public health surveillance systems should include ADI as a risk factor for longitudinal progression of cardiometabolic diseases.