title: The local geographic distribution of diabetic complications in New York City: Associated population characteristics and differences by type of complication.
abstract: OBJECTIVE
  To identify population characteristics associated with local variation in the prevalence of diabetic complications and compare the geographic distribution of different types of complications in New York City.
  
  
  METHODS
  Using an all-payer database of emergency visits, we identified the proportion of unique adults with diabetes who also had cardiac, neurologic, renal and lower extremity complications. We performed multivariable regression to identify associations of demographic and socioeconomic factors, and diabetes-specific emergency department use with the prevalence of diabetic complications by Census tract. We also used geospatial analysis to compare local hotspots of diabetic complications.
  
  
  RESULTS
  We identified 4.6million unique New York City adults, of which 10.5% had diabetes. Adjusting for demographic and socioeconomic factors, diabetes-specific emergency department use was associated with severe microvascular renal and lower extremity complications (p-values<0.001), but not with severe macrovascular cardiac or neurologic complications (p-values of 0.39 and 0.29). Our hotspot analysis demonstrated significant geographic heterogeneity in the prevalence of diabetic complications depending on the type of complication. Notably, the geographic distribution of hotspots of myocardial infarction were inversely correlated with hotspots of end-stage renal disease and lower extremity amputations (coefficients: -0.28 and -0.28).
  
  
  CONCLUSIONS
  We found differences in the local geographic distribution of diabetic complications, which highlight the contrasting risk factors for developing macrovascular versus microvascular diabetic complications. Based on our analysis, we also found that high diabetes-specific emergency department use was correlated with poor diabetic outcomes. Emergency department utilization data can help identify the location of specific populations with poor glycemic control.
authors: Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 560 First Avenue, New York, NY 10016, United States; Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States. Electronic address: david.lee@nyumc.org.
authors: David C
authors: DC
authors: Lee
authors: Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Health Equity Research, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States.
authors: Judith A
authors: JA
authors: Long
authors: Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States.
authors: Mary Ann
authors: MA
authors: Sevick
authors: Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States.
authors: Stella S
authors: SS
authors: Yi
authors: Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States.
authors: Jessica K
authors: JK
authors: Athens
authors: Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States; Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012, United States.
authors: Brian
authors: B
authors: Elbel
authors: Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 560 First Avenue, New York, NY 10016, United States.
authors: Stephen P
authors: SP
authors: Wall
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009519:New York City; D015995:Prevalence; D012307:Risk Factors
keywords: Diabetic complications; Geographic variation; Population health