Using the Neighborhood Deprivation Index, along with geocoding of primary care providers and endocrinologists, University of Florida and Stanford University researchers have identified areas in Florida and California where people with Type 1 diabetes may have difficulty getting the care and support they need to manage their disease. The findings appear in the Journal of Clinical Endocrinology & Metabolism.
“There are pervasive disparities in diabetes outcomes in the U.S., based on socioeconomic status and race and ethnic minority status,” said the study’s lead author, Ashby Walker, Ph.D., an assistant professor in the UF College of Public Health and Health Professions department of health services research, management and policy and the director for health equity initiatives at the UF Diabetes Institute. “We are seeing these inequalities exacerbated in the deleterious impacts of COVID-19 on people with diabetes from underserved communities. It is vital to develop intentional and strategic outreach programs to promote health equity in diabetes and the Neighborhood Deprivation Index is a powerful and validated tool we can use for program development.”
The Neighborhood Deprivation Index, or NDI, is calculated based on 20 different neighborhood factors covering seven domains, including poverty, occupation, housing, employment, education, racial composition and residential stability. It measures many aspects of poverty that have proven to impact community health outcomes, such as cardiometabolic risk, cancer risk and substance use.
The research team combined the NDI with endocrinology and primary care provider directories to find high-need areas for patients with Type 1 diabetes in Florida and California. Characteristics of high-need areas included more than a 30-minute drive to the nearest endocrinologist but within a 30-minute drive to the nearest primary care provider, an NDI in the highest quartile and a population above the median. They found 26 counties in Florida and 30 in California that met the criteria for high need.
“The findings did not surprise us, but they help debunk the idea that rural areas are the primary target as there are people living in non-rural areas that have high NDI scores and are in dire need of strategic outreach,” Walker said.
Walker and co-author Michael Haller, M.D., a professor in the UF College of Medicine and chief of pediatric endocrinology, lead Project ECHO Diabetes, which uses the Extension for Community Healthcare Outcomes, or ECHO, Model to empower primary care providers managing adult and pediatric patients living with Type 1 diabetes or insulin-dependent Type 2 diabetes who lack access to routine specialty care in underserved communities. Supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust, Project ECHO Diabetes reaches more than 50,000 people living with diabetes in Florida who would otherwise not have access to endocrinologists for routine diabetes care.
The NDI/geocoding approach outlined in the new study could help other ECHO programs identify vulnerable populations, Walker said.
“Our hope is that by providing information about our use of the NDI and provider geocoding, other ECHO programs can find this methodological approach useful in their own efforts at recruiting health centers in meaningful ways.”
In addition to Walker and Haller, the study team included Hui Hu, Ph.D., an assistant professor of epidemiology in the UF College of Public Health and Health Professions and the College of Medicine; Claudia Anez-Zabala, Project ECHO research coordinator and a student in UF’s master’s in public health program, social and behavioral sciences concentration; and Stanford University colleagues Katarina Yabut, Nicolas Cuttriss, M.D., M.P.H., and David Maahs, M.D., Ph.D.