Introduction and Objective: Gestational diabetes mellitus (GDM) risk varies by area and is potentially associated with social disparity and variation in the built environment. There remains limited evidence examining the association between socio-ecological factors and GDM risk. This study examined the association between socio-ecological factors and GDM risk at local area level over time in Australia.Methods: An ecological study was undertaken using multisource national data at Statistical Area Level 2 (SA2: medium-sized geographical unit) in Australia from 2016-22. SA2-level GDM cases and births were obtained from national registries. Social and built environment covariates were aggregated to the SA2 level. Spatiotemporal ecological regression was undertaken using a Bayesian approach, and an adjusted risk ratio with 95% credible intervals (CrIs) was estimated.Results: Across 1,486 SA2s, 207,163 GDM cases occurred from 1,719,396 births. In areas with a high concentration of at-risk migrant women (location quotient ≥ 1), GDM was 1.10 (95% CrI; 1.07, 1.13) compared to low concentration. GDM risk was associated with a lower level of socioeconomic position, with least (vs most) advantaged areas having an 18% greater risk of GDM (1.18[95% CrI; 1.10, 1.26]). Compared to areas with the least access to fast food outlets (4th quartile), other quartiles were associated with increased GDM risk, with the greatest in the 1st (highest access) (1.12 [95% CrI; 1.04,1.20]). Residing in the least-moderate walkable areas (2nd quartile) was associated with higher GDM risk (1.08[95% CrI; 1.02, 1.14]) than most walkable areas.Conclusion: Area-level GDM risk was associated with socioeconomic disadvantage, high concentrations of at-risk migrant women, least-moderate walkability, and highest fast-food access. Tailored population-level interventions targeting socioeconomic, ethnic, and built environment attributes may improve preventive health efforts.
W.W. Takele: None. R. Beare: None. L.L. Dalli: None. S. Lim: None. J. Boyle: Other Relationship; Elsevier.
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