OBJECTIVE This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA1c) in older adults with diabetes. RESEARCH DESIGN AND METHODS Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA1c from the time period were used and treated as time varying in analyses. SAS Proc Glimmix was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting. RESULTS Before adjustment for demographics, difficulty paying bills (0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA1c over time. CONCLUSIONS Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.

中文翻译：

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健康社会决定因素对老年糖尿病患者血糖控制的纵向影响。


目的 本研究旨在了解老年糖尿病患者的经济、社会心理和社区社会决定因素与血糖控制 (HbA1c) 之间的纵向关系。研究设计和方法 使用了参加健康与退休研究 (HRS) 的 2,662 名自报糖尿病患者的数据。参与者从 2006 年到 2014 年进行跟踪调查。经济困难、社会心理和社区层面的社会决定因素基于两年一次的核心访谈和兰德数据集的有效调查。使用该时间段内的所有社会决定因素和 HbA1c 测量值，并将其视为分析中的时间变化。 SAS Proc Glimmix 用于拟合一系列分层线性混合模型。模型使用随机截距控制重复观察之间的非独立性，并将每个参与者视为随机因素。调查方法用于应用 HRS 加权。结果 在人口统计数据调整之前，支付账单困难 (0.18 [95% CI 0.02, 0.24]) 和药物费用不依从性 (0.15 [0.01, 0.29]) 与 HbA1c 随着时间的推移而增加以及社会凝聚力 (-0.05 [-0.10]) 独立相关, -0.001]) 与 HbA1c 随着时间的推移降低独立相关。在对人口统计数据和合并症计数进行调整后，支付账单困难 (0.13 [0.03, 0.24]) 和宗教信仰 (0.04 [0.001, 0.08]) 与 HbA1c 随着时间的推移而增加独立相关。结论 通过对患有糖尿病的老年人进行纵向队列研究，这项研究发现，与心理社会和邻里因素相比，经济困难因素（例如支付账单困难）与随时间推移血糖控制恶化的关系更为一致。