# Component A: Impact of Community Factors on Geographic Disparities in Diabetes and Obesity Nationwide

> **NIH ALLCDC U01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2021 · $800,000

## Abstract

ABSTRACT
Diabetes prevalence has more than doubled in the past two decades, and now nearly 1 in 10 Americans has
diabetes. After a similar steep increase, obesity rates among US adults have been stable in the past 10 years,
but strong disparities persist and rates are still rising in some groups. Prevention efforts to date have mostly
focused on individual-level risk factors. However, a growing body of research has linked diabetes, obesity and
other cardiometabolic risk factors to a range of community characteristics, suggesting that environmental
factors can have a direct beneficial or deleterious influence on disease risk. Numerous studies have observed
significant and plausible associations between diabetes and obesity prevalence and attributes of the social and
physical environment. Some of these community factors are amenable to intervention, yet the true magnitudes
of their relative contributions, remains unclear, especially after adjusting for population characteristics. In
response to FOA-DP-17-001, we aim to collaborate with other funded Centers to examine modifiable
community characteristics that may together explain stark disparities in diabetes, obesity and other
cardiometabolic conditions in the United States using ecologic and multi-level study designs. Specifically, we
aim to use county-level prevalence data from the Behavioral Risk Factor Surveillance System (BRFSS) and
individual-level electronic medical record data from a very large national Veteran’s Administration (VA)
cohort (~4.6 million patients) to examine the relationship between key community factors pertaining to the
food and housing environment and 3 outcomes: diabetes, obesity and discordance between county-level
diabetes and obesity prevalence, an approach that allows us to examine unique contextual risk factors for each
condition. Expanding on prior work, we propose developing novel community measures that may contribute to
diabetes and obesity disparities. Our primary food environment measures to be refined, shared with other
Centers, and analyzed pertain to relative ‘food swamp’ measures (neighborhoods in which cheap, energy-
dense and pre-prepared food is a dominant option). Our primary housing environment measures to be refined,
shared and analyzed are ‘housing cost burden’ measures. We will use causal inference techniques to
strengthen our multilevel analyses (e.g. instrumental variable analysis and negative control outcomes). We will
also perform causal mediation analysis and primary data collection to examine potential mechanistic pathways
on our main study datasets. Primary data will be collected through a planned social determinant of health
survey in partnership with the New York City Health Department. Capitalizing on (1) the breadth of expertise
among New York University researchers in the areas of health surveillance, food and housing policy research,
and causal inquiry methods; (2) access to a very large cohort of VA patients; and (3) our demonstrated ...

## Key facts

- **NIH application ID:** 10379058
- **Project number:** 5U01DP006299-05
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Lorna Thorpe
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2021
- **Award amount:** $800,000
- **Award type:** 5
- **Project period:** 2017-09-30 → 2022-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10379058

## Citation

> US National Institutes of Health, RePORTER application 10379058, Component A: Impact of Community Factors on Geographic Disparities in Diabetes and Obesity Nationwide (5U01DP006299-05). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10379058. Licensed CC0.

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