Cohort Profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population†

Abstract

One of the challenges of the national initiative, Healthy People 2010,¹ is to support interventions that will reduce social disparities in health. While social disparities such as differences in education, income, race or ethnicity may affect health, the mechanisms are poorly understood. If social disparities in health originate in childhood, are current social disparities in health modifiable and are they the responsibility of a medical provider or health plan? Nonetheless, modifiable factors may exist at the individual, neighbourhood or system level that mediate (explain) social disparities in health and that may be suitable targets for interventions aiming to reduce disparities. Our aim was to survey and prospectively follow a large, diverse and well-characterized population with diabetes and to collect data on risk factors which may affect diabetes health outcomes but which may differ substantively in prevalence or effect size across ethnic groups or educational levels.