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Research assessing predictors of preventive screening often focuses on individual patient factors, despite known relationships between neighborhood environment and health. Using a retrospective cohort study of 519,826 patients meeting US Preventive Service Task Force guideline recommendation for screening for prediabetes and type 2 diabetes (age 35-70 years and BMI ≥25) from Kaiser Permanente Northern California in 2018, we used logistic regression to assess the relationship between diabetes screening and census neighborhood tract-level measures, and area gentrification measures developed by the Urban Displacement Project, controlling for age, sex, race, ethnicity, and BMI. Thirty-eight percent of patients were screened for diabetes. Patients aged 60-70 years had higher odds of diabetes screening compared to patients aged 35-39 years (OR: 2.73, 95% CI: 2.67-2.78) . Men had lower odds of screening compared to women (OR: 0.91, 0.90-0.92) . Asian patients had higher odds of screening compared to White patients (OR 1.44, 1.42-1.46) . Patients with BMI ≥40 had higher odds of screening compared to patients with BMI 25-29.9 (OR: 1.34, 1.30-1.37) . Patients living in census tracts with the lowest median values of homes (OR: 0.93, 0.90-0.96) and with the lowest median household income (OR: 0.95, 0.91-0.99) had lower odds of diabetes screening compared to those in census tracts with the highest values. Patients living in census tracts classified as Ongoing Displacement/Low Income Susceptible to Displacement had lower odds of screening (OR: 0.96, 0.93-0.98) compared to those living in stable moderate mixed income tracts. We found insufficient screening rates and that gentrification and area-level socioeconomic factors were associated with lower diabetes screening, even after adjusting for individual demographic and clinical factors. Health care systems should consider addressing social needs and community resources as a path to improving preventive care. Disclosure T.Thomas: None. W.T.Dyer: None. L.A.Rodriguez: None. J.Schmittdiel: None. Funding Kaiser Permanente Northern California Community Benefit Programs; The Permanente Medical Group (TPMG) Delivery Science Fellowship Program; National Institute of Diabetes and Digestive and Kidney Diseases grant T32DK11668401. Dr. Schmittdiel received additional support from the NIDDK-funded Health Delivery Systems Center for Diabetes Translational Research (1P30 DK92924) . |
