Built Environment: Does Poor Housing Raise Diabetes Risk?

Poor housing may increase the risk of developing diabetes mellitus among middle-aged black Americans, suggests research published in the 15 August 2007 edition of the American Journal of Epidemiology. What exactly causes this link, however, remains to be explained. " Many factors linked with the development of diabetes, such as obesity or the use of alcohol or smoking, are commonly present in the lives of people living in poorer housing, " explains first author But when his team adjusted for these factors, living in a poorly maintained house remained a significant risk for diabetes in its own right. In contrast, the quality of the neighborhood overall was not associated with increased risk. According to the American Diabetes Association, diabetes already affects some 7% of the U.S. population and 13.3% of non-Hispanic blacks, with 90% of these cases comprising type 2 diabetes. The prevalence of diabetes could double by 2050—even triple among blacks, says Schootman. To better understand why this is so, the environmental context in which individuals live, work, and play needs to be taken into account, but until now no work has focused on the effect of neighborhood and housing conditions, factors that have been associated with other health problems including depression. The researchers interviewed 644 middle aged subjects enrolled in the African American Health Study who lived in either a poor inner-city area of St. Louis or a less impoverished suburb of the city. At the time of initial interview, no subject declared having been diagnosed with diabetes (the interviewers did not ask specifically about type 1, type 2, or other types of diabetes), although 10.3% went on to develop some form of the problem within three years. During the first interviews the researchers took note of the respondents' neighborhood and personal housing conditions. Neighborhoods were rated on a four-point scale ranging from excellent to poor depending on the general condition of the houses, the amount of ambient noise, general air quality, the state of repair of the streets, and other factors. Individual respondents' housing conditions were similarly rated, on the basis of the physical condition of the interior, cleanliness, and the quality of the furnishings. " We then looked for an association between these conditions and the development of diabetes among the study subjects , " explains Schootman, " and found every housing condition rated fair to poor, as well as the overall housing rating, to be …