Spatial patterns of diabetes related health problems for vulnerable populations in Los Angeles.
BACKGROUND
Rates for Diabetes Mellitus continue to rise in most urban areas of the United States, with a disproportionate burden suffered by minorities and low income populations. This paper presents an approach that utilizes address level data to understand the geography of this disease by analyzing patients seeking diabetes care through an emergency department in a Los Angeles County hospital. The most vulnerable frequently use an emergency room as a common care access point, and such care is especially costly. A fine scale GIS analysis reveals hotspots of diabetes related health problems and provides output useful in a clinic setting. Indeed these results were used to support the work of a progressive diabetes clinic to guide management and intervention strategies.


RESULTS
Hotspots of diabetes related health problems, including neurological and kidney issues were mapped for vulnerable populations in a central section of Los Angeles County. The resulting spatial grid of rates and significance were overlaid with new patient residential addresses attending an area clinic. In this way neighbourhood diabetes health characteristics are added to each patient's individual health record. Of the 29 patients, 4 were within statistically significant hotspots for at least one of the conditions being investigated.


CONCLUSIONS
Although exploratory in nature, this approach demonstrates a novel method to conduct GIS based investigations of urban diabetes while providing support to a progressive diabetes clinic looking for novel means of managing and intervention. In so doing, this analysis adds to a relatively small literature on fine scale GIS facilitated diabetes research. Similar data should be available for most hospitals, and with due consideration for preserving spatial confidentiality, analysis outputs such as those presented here should become more commonly employed in other investigations of chronic diseases.
Curtis
Andrew J
AJ
Department of American Studies and Ethnicity, College of Letters, Arts and Sciences, University of Southern California, Los Angeles, USA. ajcurtis@usc.edu
Lee
Wei-An Andy
WA
D003920:Diabetes Mellitus / Q000453:epidemiology*; D040362:Geographic Information Systems; D005843:Geography; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008499:Medical Records; D011159:Population Surveillance / Q000379:methods; D035862:Vulnerable Populations
BMC Public Health. 2009 Mar 05;9:76
19265552
Int J Health Geogr. 2009 Feb 18;8:10
19224644
J Epidemiol Community Health. 2004 May;58(5):388-92
15082736
Int J Health Geogr. 2008 Feb 29;7:10
18312660
Int J Health Geogr. 2008 Apr 18;7:16
18423005
Soc Sci Med. 2009 Nov;69(9):1314-22
19751959
Prev Med. 2007 Mar;44(3):196-7
17222896
Nurs Outlook. 2004 May-Jun;52(3):142-6
15197363
Int J Health Geogr. 2009 Oct 08;8:54
19814809
MMWR Morb Mortal Wkly Rep. 2003 Nov 28;52(47):1152-5
14647017
Int J Health Geogr. 2007 Mar 27;6:13
17389045
Public Health Nutr. 2000 Mar;3(1):31-8
10786721
Am J Prev Med. 2008 Apr;34(4):282-90
18374241
Int J Epidemiol. 2010 Feb;39(1):277-84
19491142
Int J Health Geogr. 2006 Mar 30;5:14
16573835
J Urban Health. 2008 Mar;85(2):206-16
18247121
Ann Behav Med. 2009 Dec;38 Suppl 1:S56-73
19802648
Prev Med. 2008 Apr;46(4):331-5
18164753
Stat Med. 1996 Dec 15;15(23):2561-72
8961463
Curr Med Res Opin. 2005 Dec;21(12):1935-41
16368043
Diabetes Care. 2007 Feb;30(2):224-7
17259485
J Med Syst. 2004 Jun;28(3):223-36
15446614
Stat Med. 1996 Apr 15-May 15;15(7-9):717-26
9132899
Public Health Nurs. 2004 Nov-Dec;21(6):547-54
15566560
Int J Health Geogr. 2009 Feb 16;8:9
19220879
Ann Behav Med. 2004 Aug;28(1):20-8
15249256
Stat Med. 2000 Sep 15-30;19(17-18):2345-59
10960858
Diabetes Care. 2009 Jan;32(1):54-6
18931097
Int J Health Geogr. 2007 Feb 12;6:4
17295912
Int J Health Geogr. 2006 Oct 10;5:44
17032448
Int J Health Geogr. 2005 Aug 02;4:19
16076402
Int J Health Geogr. 2009 Nov 30;8:69
19948046