title: Self-reported neighborhood safety and nonadherence to treatment regimens among patients with type 2 diabetes.
abstract: BACKGROUND
  Few studies have explored the association between neighborhood characteristics and adherence to diabetes self-management behaviors, and none have examined the influence of neighborhood safety on adherence to treatment regimens among patients with diabetes.
  
  
  OBJECTIVE
  To assess whether neighborhood safety is associated with self-reports of technical quality of care and with nonadherence to diabetes treatment regimens.
  
  
  METHODS
  A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression models were used to examine the association of self-reported neighborhood safety with technical quality of care and treatment nonadherence, adjusted for sociodemographic characteristics, barriers to access to care, and health status.
  
  
  METHODS
  Adults with type 2 diabetes currently receiving medical treatment.
  
  
  METHODS
  Patient-reported neighborhood safety, performance of recommended processes of care by provider, treatment nonadherence (patient delays in filling prescriptions and obtaining needed medical care).
  
  
  RESULTS
  Self-reported neighborhood safety was not associated with process measures of technical quality of care, but was associated with treatment nonadherence. Specifically, compared to those who report living in a safe neighborhood, a higher proportion of patients living in unsafe neighborhoods reported delays in filling a prescription for any reason (21.9% vs. 12.8%, aOR = 1.69, 95%CI 1.19, 2.40) and delays in filling a prescription due to cost (12.2% vs. 6.8%, aOR = 1.63, 95%CI 1.02, 2.62).
  
  
  CONCLUSIONS
  Contextual factors, such as neighborhood safety, may contribute to treatment nonadherence in daily life, even when the technical quality of care delivered in the clinic is not diminished.
authors.affiliation: Health Policy Research Institute, Department of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA 92697-5800, USA. jbillime@uci.edu
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
mesh_terms: D002140:California; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012648:Self Care; D011795:Surveys and Questionnaires