Neighborhood Cohesion, Diabetes Prevalence Linked Across Demographic Groups

Investigators said data show social factors are intertwined with health outcomes.

A new report has identified associations between the social cohesion of a neighborhood and rates of type 2 diabetes (T2D), but it also shows that the association varies among demographic groups.

The authors of the study, published in Preventive Medicine, say the report highlights the importance of nuanced research and nuanced public health interventions.

They explained that a growing body of evidence shows associations between diabetes-related health factors and neighborhood environments.

“Physical and social features of the neighborhood environment may contribute to the prevalence of T2D through health constraining or enhancing factors, such as access to grocery stores and parks with green space, perceived neighborhood safety, and neighborhood social cohesion,” they wrote.

The latter term—neighborhood social cohesion—is a measure of connectedness, solidarity, and trust among people in a given neighborhood, they said.

“Research has shown that neighborhoods perceived as having high social cohesion are associated with higher rates of physical activity, lower incidence of T2D, and lower prevalence of cardiovascular diseases, including myocardial infarction and stroke,” they wrote.

In the case of T2D, the inverse is also true: Neighborhoods with low levels of social cohesion tend to have higher rates of T2D, studies suggest.

Still, the study investigators wondered if the links between social cohesion and T2D prevalence might vary based on demographic factors such as age, sex, gender, and racial or ethnic group.

They turned to the National Health Interview Survey, retrieving data from 2013 to 2018. The data set included 170,432 adults. Their mean age was 47.4 years, 52% were women, and 69% identified as non-Hispanic. The authors then analyzed rates of diabetes to compare it to self-reported neighborhood social cohesion, which was categorized as low, medium, or high.

In most cases, the authors found that people living in neighborhoods with lower social cohesion had a greater prevalence of T2D. Overall, people who lived in a low-social cohesion neighborhood had a 22% higher prevalence of T2DM compared with people living in high-cohesion neighborhoods. Low neighborhood cohesion was also associated with a greater risk of T2D for people aged 31 to 49 years and for people 50 years and older. Hispanic/Latinx women aged 18 to 30 years had a nearly 4-fold higher risk of T2D if they lived in a low-cohesion neighborhood compared with a high-cohesion neighborhood (prevalence risk [PR], 3.70; 95% CI, 1.40-9.80). However, non-Hispanic Black women of the same age group had a lower prevalence of T2DM if they lived in a medium-cohesive neighborhood compared with a high-cohesion neighborhood (PR, 0.35; 95% CI, 0.14-0.89).

The investigators said their results show that it is important to consider how multiple social factors can intersect and interact to influence public health. They added that it is also important to realize such factors are not permanent.

“Our findings contribute to the literature by demonstrating an association between a modifiable feature of the neighborhood social environment and T2D, which may serve as an effective intervention target,” they wrote.

The authors said future research should take an intersectional perspective and think about differences between subpopulations.


Williams PC, Alhasan DM, Gaston SA, Henderson KL, Braxton Jackson W 2nd, Jackson CL. Perceived neighborhood social cohesion and type 2 diabetes mellitus by age, sex/gender, and race/ethnicity in the United States. Prev Med. Published online March 12, 2023. doi:10.1016/j.ypmed.2023.107477

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