Where You Live Shapes Diabetes Risk
Multilevel Determinants of Type 2 Diabetes in the East South Central United States
Bibliographic Data
| ID | 22021785 |
|---|---|
| Authors | Ferial Ahmadi (0000-0001-5901-6072, University of Memphis), Maryam Karimi (0000-0003-3993-644X, University of Memphis), Rouzbeh Nazari (0000-0002-0664-438X, University of Memphis, corresponding author), Alireza Eskandarinejad (0000-0001-8831-2807, University of Memphis), Mohammad Reza Nikoo (0000-0002-3740-4389, Sultan Qaboos University) |
| Year | 2026 |
| Publication date | 2026-07-09 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Racial and Ethnic Health Disparities (JOURNAL) |
| Journal identifiers | ISSN: 2196-8837 • E-ISSN: 2197-3792 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1007/s40615-026-03110-y |
| PMID | 42424017 |
| OpenAlex | W7167812808 |
| Language | EN |
| References cited | 61 |
Type 2 diabetes melittus (T2DM) remains a major public health challenge in the United States, particularly in the east south central regions. his study investigated behavioral, socioeconomic, and built environment determinants of county-level diabetes prevalence across Alabama, Kentucky, Mississippi, and Tennessee using linear mixed-effects and Random Forest models. The results indicated that food insecurity (β = 0.057, p < 0.001), smoking (β = 0.151, p < 0.001), poverty (β = 0.027, p < 0.001), the percentage of uninsured individuals (β = 0.072, p < 0.001), and the percentage of Black residents (β = 0.058, p < 0.001) were significantly associated with higher T2DM prevalence. Significant interactions were observed between obesity and physical inactivity (β = 0.0030, p < 0.001), obesity and alcohol consumption (β = − 0.0120, p < 0.001), and obesity and social deprivation (β = − 0.00081, p < 0.001), indicating that the association between obesity and diabetes prevalence varied according to behavioral and socioeconomic conditions. The Random Forest model demonstrated strong predictive performance (R2 = 0.884) and identified binge drinking, the percentage of Black residents, physical inactivity, poverty, obesity, food insecurity, and social deprivation as the most influential predictors. The consistency in findings across both multilevel and machine learning approaches highlights the combined influence of behavioral, socioeconomic, and environmental factors in shaping regional diabetes disparities and underscores the need for targeted public health interventions to reduce diabetes-related health inequities in the U.S. east south regions
Multilevel model · Obesity · Poverty · Psychological intervention · Public health · Social determinants of health · Socioeconomic status · Type 2 diabetes · Diabetes Management and Education · Diabetes, Cardiovascular Risks, and Lipoproteins · Nutritional Studies and Diet
| Highly cited | No |
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