Neighbourhood disadvantage and self-reported type 2 diabetes, heart disease and comorbidity: A cross-sectional multilevel study

Purpose: 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.