title: Neighbourhood disadvantage and self-reported type 2 diabetes, heart disease and comorbidity: a cross-sectional multilevel study.
abstract: OBJECTIVE
  This study examines associations between neighborhood socioeconomic disadvantage and self-reported type 2 diabetes and heart disease, occurring separately and concurrently at a single time point (comorbidity).
  
  
  METHODS
  This study included 11,035 residents from 200 neighborhoods in Brisbane, Australia. Respondents self-reported type 2 diabetes and heart disease as long-term health conditions. Neighborhood socioeconomic disadvantage was measured using a census-derived composite index. Individual socioeconomic position was measured using education, occupation, and household income. Data were analyzed using multilevel multinomial mixed-effects logistic regression using Markov chain Monte Carlo simulation.
  
  
  RESULTS
  Compared with the most advantaged neighborhoods, residents of the most-disadvantaged neighborhoods were more likely to report type 2 diabetes (odds ratio [OR] = 2.21, 95% credible interval [CrI] = 1.55-3.15), heart disease (OR = 1.72, 95% CrI = 1.25-2.38), and comorbidity (OR = 4.38, 95% CrI = 2.27-8.66). This relationship attenuated after adjustment for individual-level socioeconomic position, but remained statistically significant for type 2 diabetes (OR = 1.81, 95% CrI = 1.15-2.83) and comorbidity (OR = 3.00, 95% CrI = 1.49-6.13).
  
  
  CONCLUSIONS
  Studies of neighborhood disadvantage that fail to include individual-level socioeconomic measures may inflate associations. Establishing why residents of disadvantaged neighborhoods are more likely to experience the co-occurrence of heart disease and type 2 diabetes independent of their individual socioeconomic position warrants further investigation.
authors.affiliation: School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. Electronic address: j.rachele@qut.edu.au.
authors.forename: Jerome N
authors.initials: JN
authors.lastname: Rachele
authors.affiliation: McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
authors.forename: Billie
authors.initials: B
authors.lastname: Giles-Corti
authors.affiliation: School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Turrell
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D054624:Health Status Disparities; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D016017:Odds Ratio; D012111:Residence Characteristics; D057566:Self Report; D012959:Socioeconomic Factors
keywords: Chronic disease; Comorbidity; Heart disease; Multilevel; Neighborhood disadvantage; Socioeconomic disadvantage; Type 2 diabetes