Patterns of Adapting to Health, Self-Reported Health Status, and Risk of Type 2 Diabetes
Abstract
Problem. The incidence of Type 2 diabetes is expected to more than double over the next three decades. Several behavioral drivers of Type 2 diabetes have been identified. Cluster-based studies support the self-organization of health-related behavior in specific patterns with their own effects on population health. The Patterns of Adapting to Health (PATH) system of health-related behavior patterns were hypothesized to influence Type 2 diabetes incidence both directly and indirectly. Participants: 4,380 Hawaii-based health plan members including 1,412 Type 2 diabetics responded to a mail survey. Methods: Self-reported health status was measured with a subset of items from the SF-36. The Adaptive Health Behavior Inventory (AHBI) assessed multiple health-related behaviors used as inputs to identify the nine PATH. Multiple regression and logistic regression evaluated the PATH effects on self-reported health status and the odds of Type 2 diabetes after controlling for self-reported health status, respectively. Results: Five PATH had significant lowering or raising effects on self-reported health status, β = -.05 [99%CI: -.42 to -.04] to β = .17 [99%CI: .35 to .64]. Two of the nine PATH were associated with increased odds of Type 2 diabetes, OR = 2.86 [99%CI: 1.31 to 6.24] to OR = 3.84 [99%CI: 1.41 to 6.84]. Conclusions: Two population-level patterns of health behavior were associated with increased risk odds of Type 2 diabetes after controlling for health status. Implications: Addressing individual behavioral drivers of Type 2 diabetes may be insufficient to counter the effects of population-level patterns of behavior on Type 2 diabetes incidence.
Problem. The incidence of Type 2 diabetes is expected to more than double over the next three decades. Several behavioral drivers of Type 2 diabetes have been identified. Cluster-based studies support the self-organization of health-related behavior in specific patterns with their own effects on population health. The Patterns of Adapting to Health (PATH) system of health-related behavior patterns were hypothesized to influence Type 2 diabetes incidence both directly and indirectly. Participants: 4,380 Hawaii-based health plan members including 1,412 Type 2 diabetics responded to a mail survey. Methods: Self-reported health status was measured with a subset of items from the SF-36. The Adaptive Health Behavior Inventory (AHBI) assessed multiple health-related behaviors used as inputs to identify the nine PATH. Multiple regression and logistic regression evaluated the PATH effects on self-reported health status and the odds of Type 2 diabetes after controlling for self-reported health status, respectively. Results: Five PATH had significant lowering or raising effects on self-reported health status, β = -.05 [99%CI: -.42 to -.04] to β = .17 [99%CI: .35 to .64]. Two of the nine PATH were associated with increased odds of Type 2 diabetes, OR = 2.86 [99%CI: 1.31 to 6.24] to OR = 3.84 [99%CI: 1.41 to 6.84]. Conclusions: Two population-level patterns of health behavior were associated with increased risk odds of Type 2 diabetes after controlling for health status. Implications: Addressing individual behavioral drivers of Type 2 diabetes may be insufficient to counter the effects of population-level patterns of behavior on Type 2 diabetes incidence.