title: Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients.
abstract: Racial variation in the relationship between blood glucose and hemoglobin A1c (HbA1c) complicates diabetes diagnosis and management in racially mixed populations. Understanding why HbA1c is persistently higher in blacks than whites could help reduce racial disparity in diabetes outcomes.
  
  
  
  Test the hypothesis that neighborhood disadvantage is associated with inflammation and poor metabolic control in a racially mixed population of pediatric type 1 diabetes patients.
  
  
  
  Patients (n = 86, 53 white, 33 black) were recruited from diabetes clinics. Self-monitored mean blood glucose (MBG) was downloaded from patient glucose meters. Blood was collected for analysis of HbA1c and C-reactive protein (CRP). Patient addresses and census data were used to calculate a concentrated disadvantage index (CDI). High CDI reflects characteristics of disadvantaged neighborhoods.
  
  
  
  HbA1c and MBG were higher (p < 0.0001) in blacks [10.4% (90.3 mmol/mol), 255 mg/dL] than whites [8.9% (73.9 mmol/mol), 198 mg/dL). CDI was higher in blacks (p < 0.0001) and positively correlated with HbA1c (r = 0.40, p = 0.0002) and MBG (r = 0.35, p = 0.0011) unless controlled for race. CDI was positively associated with CRP by linear regression within racial groups. CRP was not different between racial groups, and was not correlated with MBG, but was positively correlated with HbA1c when controlled for race (p = 0.04).
  
  
  
  Neighborhood disadvantage was associated with inflammation and poor metabolic control in pediatric type 1 diabetes patients. Marked racial differences in potential confounding factors precluded differentiation between genetic and environmental effects. Future studies should recruit patients matched for neighborhood characteristics and treatment regimen to more comprehensively assess racial variation in HbA1c.
authors.affiliation: School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Coulon
authors.affiliation: School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Cruz
authors.initials: C
authors.lastname: Velasco-Gonzalez
authors.affiliation: School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.|Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Scribner
authors.affiliation: School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.|Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Chi L
authors.initials: CL
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gomez
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vargas
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stender
authors.affiliation: Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Jovanny
authors.initials: J
authors.lastname: Zabaleta
authors.affiliation: Research Institute for Children, Children's Hospital, New Orleans, LA, USA.
authors.forename: Patrice
authors.initials: P
authors.lastname: Clesi
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Chalew
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.|Research Institute for Children, Children's Hospital, New Orleans, LA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Hempe
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000208:ethnology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D054624:Health Status Disparities; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000208:ethnology*; D008297:Male; D055820:New Orleans / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012648:Self Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: hemoglobin A1c; inflammation; racial bias; socioeconomic factors; type 1 diabetes mellitus