Purpose: Neighborhood characteristics such as violence, crime, and poor social support are barriers to glycemic control; however, prior research has largely focused on individuals with diabetes at a single time point. Less is known about the role of perceived neighborhood factors in glycemic control among those without diabetes or whether these associations change as people age. We examined associations between perceived neighborhood environment (safety, disorder, and social cohesion) and HbA1c levels and whether these associations changed over time as participants aged and differed by self-reported diabetes status.

Methods: We analyzed data from the Health and Retirement Study, including 5,507 participants in 2006 and 2,553 in 2016 (mean ages 67.1 and 74.0 years). Perceived neighborhood safety, disorder, and social cohesion were self-reported. Continuous HbA1c levels were used as the outcome. Multiple linear regression models were conducted separately by survey year and stratified by self-reported diabetes status.

Results: Associations differed across years and by diabetes status. Higher perceived neighborhood unsafety and lower social cohesion were associated with higher HbA1c in both years (Table), whereas higher neighborhood disorder was associated with higher HbA1c only in 2006 (β: 0.04; 95% CI: 0.01, 0.07). Among participants without diabetes, higher unsafety (β: 0.02; 95% CI: 0.004, 0.04) and disorder (β: 0.03; 95% CI: 0.01, 0.05) were associated with higher HbA1c in 2006, but in 2016 only lower social cohesion was associated with higher HbA1c (β: 0.02; 95% CI: 0.001, 0.04). Among those with diabetes, only higher unsafety in 2006 was associated with higher HbA1c (β: 0.13; 95% CI: 0.05, 0.21).

Conclusion: Perceived neighborhood environment was associated with glycemic levels. The associations changed as participants aged and depended on diabetes status. Further research is needed to clarify mechanisms underlying these changes.