Perinatal & Pediatric
Ethnic Enclaves and Gestational Diabetes Risk Across Asian American Ethnic Groups: A Population-Based Study Clara Voong* Clara Voong Voong Voong Voong Voong Voong Voong Voong School of Public Health, University of California, Berkeley
Background: Asian American (AA) individuals experience the highest rate of gestational diabetes (GDM) with substantial variation across ethnic groups. Ethnic enclaves, areas concentrated with residents sharing an ethnic background, reflect social influences on health, yet their role in GDM risk among diverse AA groups is unclear.
Objective: We examined the association of pre-pregnancy ethnic enclave residence and mobility with GDM risk among AA individuals overall and across five groups.
Methods: We conducted a population-based study of 82,609 pregnant AA individuals at Kaiser Permanente Northern California from 2011 to 2022. In the year before pregnancy, enclave residence was assessed using the census-tract level AA Ethnic Enclave Index linked to the longest-held address, while enclave mobility based on full residential history was categorized as non-enclave only, enclave-exit, enclave-entry, and enclave only. Using Poisson generalized estimating equations, we estimated adjusted relative risks (aRR) and 95% CI for GDM in association with AA enclave residence and mobility. Models were adjusted for sociodemographic and clinical covariates and stratified by ethnic group.
Results: Overall, 15% were diagnosed with GDM and 79% lived in AA enclaves. Enclave residence was associated with higher GDM risk (aRR 1.18; 95% CI 1.07-1.30). Chinese (1.17; 1.06-1.29) and Filipino (1.08; 1.00-1.16) enclave residents had higher GDM risk compared to non-residents, with no differences among Vietnamese, Indian, or Other groups. Compared to non-enclave only residents, enclave only residents had a higher GDM risk (1.19; 1.07-1.32), whereas enclave-exit and enclave-entry groups were not associated with GDM.
Conclusions: Among AA populations, enclave residents had higher GDM risk with variation across ethnic groups. Findings point to the potential importance of structural and contextual factors shaping GDM risk among AA communities and inform neighborhood-focused prevention strategies.