201
|
Campbell DJT, Manns BJ, Hemmelgarn BR, Sanmartin C, King-Shier KM. Development of a conceptual framework for understanding financial barriers to care among patients with cardiovascular-related chronic disease: a protocol for a qualitative (grounded theory) study. CMAJ Open 2016; 4:E304-8. [PMID: 27398378 PMCID: PMC4933648 DOI: 10.9778/cmajo.20160030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with cardiovascular-related chronic diseases may face financial barriers to accessing health care, even in Canada, where universal health care insurance is in place. No current theory or framework is adequate for understanding the impact of financial barriers to care on these patients or how they experience financial barriers. The overall objective of this study is to develop a framework for understanding the role of financial barriers to care in the lives of patients with cardiovascular-related chronic diseases and the impact of such barriers on their health. METHODS We will perform an inductive qualitative grounded theory study to develop a framework to understand the effect of financial barriers to care on patients with cardiovascular-related chronic diseases. We will use semistructured interviews (face-to-face and telephone) with a purposive sample of adult patients from Alberta with at least 1 of hypertension, diabetes, heart disease or stroke. We will analyze interview transcripts in triplicate using grounded theory coding techniques, including open, focused and axial coding, following the principle of constant comparison. Interviews and analysis will be done iteratively to theoretical saturation. Member checking will be used to enhance rigour. INTERPRETATION A comprehensive framework for understanding financial barriers to accessing health care is instrumental for both researchers and clinicians who care for patients with chronic diseases. Such a framework would enable a better understanding of patient behaviour and nonadherence to recommended medical therapies and lifestyle modifications.
Collapse
Affiliation(s)
- David J T Campbell
- Department of Community Health Sciences (Campbell, Manns, Hemmelgarn, Sanmartin, King-Shier); Department of Medicine (Campbell, Manns, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Health Analysis Division (Sanmartin), Statistics Canada, Ottawa, Ont.; Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta
| | - Braden J Manns
- Department of Community Health Sciences (Campbell, Manns, Hemmelgarn, Sanmartin, King-Shier); Department of Medicine (Campbell, Manns, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Health Analysis Division (Sanmartin), Statistics Canada, Ottawa, Ont.; Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta
| | - Brenda R Hemmelgarn
- Department of Community Health Sciences (Campbell, Manns, Hemmelgarn, Sanmartin, King-Shier); Department of Medicine (Campbell, Manns, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Health Analysis Division (Sanmartin), Statistics Canada, Ottawa, Ont.; Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta
| | - Claudia Sanmartin
- Department of Community Health Sciences (Campbell, Manns, Hemmelgarn, Sanmartin, King-Shier); Department of Medicine (Campbell, Manns, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Health Analysis Division (Sanmartin), Statistics Canada, Ottawa, Ont.; Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta
| | - Kathryn M King-Shier
- Department of Community Health Sciences (Campbell, Manns, Hemmelgarn, Sanmartin, King-Shier); Department of Medicine (Campbell, Manns, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Health Analysis Division (Sanmartin), Statistics Canada, Ottawa, Ont.; Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alta
| |
Collapse
|
202
|
Jo EK, Seo EW, Lee KS. Spatial Distribution of Diabetes Prevalence Rates and Its Relationship with the Regional Characteristics. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
203
|
Decomposing socioeconomic inequalities in the use of preventive eye screening services among individuals with diabetes in Korea. Int J Public Health 2016; 61:613-20. [DOI: 10.1007/s00038-016-0804-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 02/08/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022] Open
|
204
|
Achuko O, Walker RJ, Campbell JA, Dawson AZ, Egede LE. Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes. Diabetes Technol Ther 2016; 18:151-8. [PMID: 26866351 PMCID: PMC4790216 DOI: 10.1089/dia.2015.0305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Discrimination is a social determinant that has been linked to poor physical and mental health outcomes. This study aimed to examine the pathway whereby discrimination influences quality of life in patients with type 2 diabetes. SUBJECTS AND METHODS Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Measures included perceived discrimination, perceived stress, social support, and social cohesion and were based on a theoretical model for the pathways by which perceived discrimination influences mental and physical health. Quality of life was measured using the SF-12 questionnaire. RESULTS The final model [χ(2)(106) = 157.35, P = 0.009, R(2) = 0.99, root mean square error of approximation = 0.03, comparative fit index = 0.99] indicates direct effects of higher perceived stress (r = -1.02, P < 0.05) and lower social support (r = 0.36, P < 0.001) significantly related to decreased mental health component score (MCS) of quality of life. Discrimination and social cohesion were not significantly directly related to MCS. However, higher discrimination (r = 0.47, P < 0.001), higher social cohesion (r = 0.14, P < 0.05), and lower social support (r = -0.43, P < 0.001) were significantly directly related to increased stress. No significant paths were found for the physical component score of quality of life. CONCLUSIONS Perceived discrimination was significantly associated with stress and served as a pathway to influence the mental health component of quality of life (MCS). Social support had a direct and an indirect effect on MCS through a negative association with stress. These results suggest that future interventions should be developed to decrease stress and increase social support surrounding discrimination to improve the MCS of quality of life in patients with diabetes.
Collapse
Affiliation(s)
- Obinna Achuko
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston VA Health Services Research and Development COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Aprill Z. Dawson
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston VA Health Services Research and Development COIN, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
205
|
|
206
|
Abstract
AIMS AND OBJECTIVES To examine and critique various models guiding the care and education of people with diabetes, to develop more helpful and effective approaches to care. The focus is on relationships and communication between patients and healthcare providers. BACKGROUND Many patients are not adhering to the recommended treatments, hence it seems that effective diabetes care is difficult to achieve, particularly for patients of lower socio-economic status, who are disproportionately afflicted. The results are usually devastating, and lead to serious health complications that incisively diminish quality of life for patients with diabetes, frustrate healthcare providers and increase healthcare costs. DESIGN Critical review. METHOD This paper represents a critical review of various approaches to diabetes care and education. A CINAHL search with relevant key words was carried out and selected exemplary research studies and articles describing and/or evaluating the various approaches to diabetes care and management were examined. Particular attention was paid to how the paradigmatic underpinnings of these approaches construct patient - healthcare provider relationships. CONCLUSION The literature revealed that the traditional top-down approaches to care were largely ineffective, while collaborative approaches, based in respect and taking the whole persons and their unique situations into account, were found to be central to good care. Further, an integration of the different kinds of knowledge contained in the various approaches can complement and extend one another. RELEVANCE TO CLINICAL PRACTICE Avoiding devastating complications by improving the management of diabetes and overall quality of life of patients is a worthwhile goal. Therefore expanding diabetes care beyond the traditional bio-medical model to develop more effective approaches to care is of interest to all healthcare professionals working in this area.
Collapse
Affiliation(s)
- Isolde Daiski
- Associate Professor, School of Nursing, York University, Toronto, Canada
| |
Collapse
|
207
|
Socioeconomic deprivation remains a significant barrier in the choice of bariatric surgery even when full medical expense coverage is present. Surg Obes Relat Dis 2016; 12:1403-1409. [PMID: 27178612 DOI: 10.1016/j.soard.2016.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/03/2016] [Accepted: 01/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of obesity is increasing in the socioeconomically deprived sector of the French population. OBJECTIVES Our objective was to assess whether the presence of a socioeconomic gradient could affect access to bariatric surgery in a publicly funded healthcare system with full medical expense coverage. SETTING The study was conducted at a general hospital and a health examination center. METHODS We prospectively included 100 patients who were admitted to the hospital for a preoperative bariatric surgery evaluation. As a reference group, we included 578 patients from the same area with body mass index (BMI) values≥35 kg/m² who visited the health center for regular medical, cardiovascular checkups. The patients were required to complete the Evaluation of Precariousness and Health Inequalities in Health Examination Centers (EPICES) questionnaire to investigate deprivation (deprivation cutoff≥30.17). RESULTS A total of 94 patients had complete data, with a mean EPICES score of 37.7±19.1 (P<.001). Patients were younger (mean age 39.2±12.7 years, P<.001), had a stronger female predominance (87%, P = .030), and higher mean BMI (43.3±6.9 kg/m², P<.001) than the reference group and were less socioeconomically deprived (64% versus 82% in the reference group, P<.001). No significant correlations existed among BMI, participant age, and deprivation score. In a subsequent age- and BMI-matched analysis, bariatric surgery candidates exhibited lower levels of deprivation. CONCLUSIONS The presence not only of material (e.g., coverage for medical expenses) but also social support is an important step toward the acceptance of bariatric surgery by morbidly obese patients.
Collapse
|
208
|
Wan TTH, Lin YL, Ortiz J. Racial Disparities in Diabetes Hospitalization of Rural Medicare Beneficiaries in 8 Southeastern States. Health Serv Res Manag Epidemiol 2016; 3:2333392816671638. [PMID: 28462283 PMCID: PMC5266462 DOI: 10.1177/2333392816671638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 12/03/2022] Open
Abstract
This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs). The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM) hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47) to the post-ACA period (1.73) for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.
Collapse
Affiliation(s)
- Thomas T. H. Wan
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Yi-Ling Lin
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Judith Ortiz
- College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
209
|
Virtanen M, Vahtera J, Head J, Dray-Spira R, Okuloff A, Tabak AG, Goldberg M, Ervasti J, Jokela M, Singh-Manoux A, Pentti J, Zins M, Kivimäki M. Work Disability among Employees with Diabetes: Latent Class Analysis of Risk Factors in Three Prospective Cohort Studies. PLoS One 2015; 10:e0143184. [PMID: 26569491 PMCID: PMC4646666 DOI: 10.1371/journal.pone.0143184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability. METHODS Participants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis. RESULTS Separate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the 'high-risk' group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38-1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21-1.46). These associations were similar in men and women, younger and older participants, and across occupational groups. CONCLUSIONS Diabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.
Collapse
Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
| | - Jussi Vahtera
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Rosemary Dray-Spira
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
| | - Annaleena Okuloff
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
| | - Adam G. Tabak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- 1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marcel Goldberg
- Population-based Cohorts Unit, Inserm UMS 011, Villejuif, France
- University Versailles Saint Quentin en Yvelines, Versailles, France
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
| | - Markus Jokela
- Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
| | - Marie Zins
- Population-based Cohorts Unit, Inserm UMS 011, Villejuif, France
- University Versailles Saint Quentin en Yvelines, Versailles, France
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
210
|
Walker RJ, Smalls BL, Egede LE. Social determinants of health in adults with type 2 diabetes--Contribution of mutable and immutable factors. Diabetes Res Clin Pract 2015; 110:193-201. [PMID: 26411692 PMCID: PMC4681588 DOI: 10.1016/j.diabres.2015.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/13/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
AIMS Socioeconomic, psychosocial, and neighborhood factors influence clinical outcomes and self-care behaviors in diabetes; however, few studies simultaneously assessed the impact of multiple social determinant of health factors on glycemic control. We used an explanatory model to examine the differential contribution of social determinants and clinical factors on glycemic control. Secondarily, we examined the contribution of mutable and immutable factors to identify meaningful future interventions. METHODS Six hundred and fifteen adults with type 2 diabetes in the southeastern United States were recruited. A hierarchical model was run with HbA1c as the dependent variable and independent variables entered in blocks: demographics (block 1), socioeconomic (block 2), psychosocial (block 3), built environment (block 4), clinical (block 5), and knowledge/self-care (block 6). RESULTS Significant associations for HbA1c included self-efficacy (β=-0.10, p<0.001), social support (β=0.01, p<0.05), comorbidity (β=-0.09, p<0.05), insulin use (β=0.95, p<0.001), medication adherence (β=-0.11, p<0.05), and being a former smoker (β=0.34, p<0.05); accounting for 24.4% of the variance. CONCLUSIONS Important factors that drive glycemic control are mutable, and amenable to health interventions. Greater attention should be given to interventions that increase self-efficacy and social support, reduce the burden of comorbidities, and enhance medication adherence and smoking cessation.
Collapse
Affiliation(s)
- Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
| | - Brittany L Smalls
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
211
|
Antipsychotic prescribing in youths: a French community-based study from 2006 to 2013. Eur Child Adolesc Psychiatry 2015; 24:1181-91. [PMID: 25564132 DOI: 10.1007/s00787-014-0668-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/17/2014] [Indexed: 01/15/2023]
Abstract
The objectives were to explore in a community-based sample of persons aged 0-25 years: (1) trends in antipsychotic prescribing, (2) characteristics of the zone of residence associated with antipsychotic prescribing rates, and (3) the pattern of antipsychotic prescribing. The study was performed using reimbursement data from the French Insurance Healthcare system. Prescribing trends were investigated over the period 2006-2013. An ecological design was used to assess the impact of the socio-economical and health resource characteristics of the zone of residence (n = 96 administrative subdivisions of French territory) on antipsychotic prescribing rates. The pattern of antipsychotic prescribing was explored in a cohort of youths newly treated with antipsychotics. Over the period 2006-2013, antipsychotic dispensing rates were stable in persons aged 0-25 years (4.8 per 1,000 in 2006 and 4.9 per 1,000 in 2013). First-generation antipsychotic dispensing rates decreased from 3.1 to 2.6 per 1,000 (OR = 0.96, 95% CI 0.94-0.98), while second-generation antipsychotic dispensing rates increased from 2.7 to 3.4 per 1,000 (OR = 1.03, 95% CI 1.01-1.05). Antipsychotic prescribing rates were impacted by health resource characteristics of the zone of residence in children aged 10 years and under and by socio-economical characteristics in those aged 16-20 years. In all the age groups, antipsychotics were principally started by hospital practitioners (47%) and general practitioners (34%). The rates of psychostimulants concomitantly prescribed with antipsychotics were lower than 5%. In conclusion, rates of youths exposed to second-generation antipsychotics are still rising. The impact of environmental characteristics on antipsychotics prescribing and appropriateness of these prescriptions in youths should be further investigated.
Collapse
|
212
|
Odume BB, Ofoegbu OS, Aniwada EC, Okechukwu EF. The influence of family characteristics on glycaemic control among adult patients with type 2 diabetes mellitus attending the general outpatient clinic, National Hospital, Abuja, Nigeria. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1090688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
213
|
Tchicaya A, Lorentz N, Demarest S, Beissel J, Wagner DR. Relationship between self-reported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg. Health Qual Life Outcomes 2015; 13:149. [PMID: 26385815 PMCID: PMC4575476 DOI: 10.1186/s12955-015-0348-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/12/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the relationship between self-reported weight change, socio-economic status, and health-related quality of life (HRQOL) in patients with diabetes, 5 years after they underwent coronary angiography. METHODS Between 2013 and 2014, 1873 of 4391 patients (319 with diabetes) who underwent coronary angiography between 2008 and 2009 participated in a follow-up study. Three out of four domains of the World Health Organization Quality of Life (WHOQOL)-BREF (physical health, psychological health and social relationships) were surveyed during the follow-up period. To assess the relationship between weight change and HRQOL, generalized linear models were constructed for every dimension of the WHOQOL-BREF, with educational level as a predictor and sex, age, marital status, smoking status, hypertension, cholesterol, ischemic heart disease, acute myocardial infarction, and stable angina pectoris as covariates. RESULTS The mean age of the patients was 70 years and almost three-quarters of the patients (72.7 %) were men. During the 12 months preceding the follow-up survey, 22.6 % of the patients reported weight loss, 20 % reported weight gain, and 57.4 % reported no weight change. There were significant differences in the HRQOL scores between patients who reported weight loss and those who reported either weight gain or unchanged weight. The most affected domains were physical and psychological health, with higher scores for patients who reported weight loss (54.7 and 67.2, respectively) than those who reported weight gain (46.3 and 58.5, respectively). The generalized linear model confirmed higher HRQOL scores among patients who reported weight loss and revealed an association between the HRQOL score and education level. CONCLUSION Weight change and education level were associated with HRQOL in patients with diabetes. Self-reported weight loss and no weight change were positively associated with HRQOL in patients with diabetes, while weight gain was negatively associated with HRQOL.
Collapse
Affiliation(s)
- Anastase Tchicaya
- LISER -Luxembourg Institute of Socio-Economic Research, 3 Avenue de la fonte, L-4364, Esch/Alzette, Luxembourg.
| | - Nathalie Lorentz
- LISER -Luxembourg Institute of Socio-Economic Research, 3 Avenue de la fonte, L-4364, Esch/Alzette, Luxembourg
| | | | - Jean Beissel
- INCCI-Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - Daniel R Wagner
- INCCI-Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| |
Collapse
|
214
|
Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015; 73:643-60. [PMID: 26307238 PMCID: PMC4586446 DOI: 10.1093/nutrit/nuv027] [Citation(s) in RCA: 655] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT It is well established in the literature that healthier diets cost more than unhealthy diets. OBJECTIVE The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. DATA SOURCES A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. STUDY SELECTION Publications linking food prices, dietary quality, and socioeconomic status were selected. DATA EXTRACTION Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. DATA SYNTHESIS Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. CONCLUSIONS Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
Collapse
Affiliation(s)
- Nicole Darmon
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
| | - Adam Drewnowski
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| |
Collapse
|
215
|
August KJ, Billimek J. A theoretical model of how neighborhood factors contribute to medication nonadherence among disadvantaged chronically ill adults. J Health Psychol 2015; 21:2923-2933. [PMID: 26089191 DOI: 10.1177/1359105315589391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In addition to individual-level socioeconomic and psychological factors, the neighborhood environment has been found to be related to medication nonadherence, particularly among low-income, minority populations managing a chronic disease. In this article, we synthesize the relevant literature on how neighborhood factors contribute to engagement in health behaviors and reasons for medication nonadherence among this population. We propose a theoretical framework for understanding the mediating and moderating mechanisms whereby the neighborhood environment may impact medication nonadherence among individuals most at risk for adverse disease outcomes. Guided by this model, we provide recommendations for future research, practice, and policy.
Collapse
|
216
|
Strongman H, D'Oca K, Langerman H, Das R. Comparison of diabetes-associated secondary healthcare utilization between alternative oral antihyperglycaemic dual therapy combinations with metformin in patients with type 2 diabetes: an observational cohort study. Diabetes Obes Metab 2015; 17:573-580. [PMID: 25735201 DOI: 10.1111/dom.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/06/2015] [Accepted: 02/27/2015] [Indexed: 12/01/2022]
Abstract
AIMS To compare diabetes-associated secondary healthcare utilization in patients with type 2 diabetes (T2DM) prescribed sulphonylureas (SUs) versus other oral antihyperglycaemic agents (OHAs) as an add-on to metformin monotherapy (metformin + SU vs metformin + OHA). METHODS This retrospective cohort study used data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. Adults with T2DM initiated on metformin + SU or metformin + OHA from April 2003 to March 2012 were identified. Patients were matched using propensity scores. Diabetes-associated secondary healthcare visits were counted from >6 months post-initiation of dual therapy until treatment change or end of follow-up. Outcomes were calculated as rate ratios, adjusted for over-dispersion using negative binomial regression and propensity score for covariates. RESULTS After propensity score matching, 1704 patients were included in each cohort. For the primary objective (diabetes-associated inpatient and outpatient visits combined), the metformin + SU cohort had a directionally higher rate of diabetes-associated secondary healthcare utilization than the metformin + OHA cohort [adjusted rate ratio 1.12, 95% confidence interval (CI) 0.97-1.29]. For the secondary outcomes, the adjusted rate ratio was 1.38 (95% CI 0.95-2.00) for inpatient admissions and 1.10 (95% CI 0.95-1.28) for outpatient visits. Macrovascular complications, accounting for 77.2% of inpatient admissions, occurred at a statistically significantly higher rate in the metformin + SU cohort than in the metformin + OHA cohort (adjusted rate ratio 1.77, 95% CI 1.15-2.71). CONCLUSIONS This study found a statistically significant higher rate of inpatient admissions for macrovascular complications and cardiology outpatient visits and, overall, a directionally higher rate of secondary healthcare utilization for patients prescribed metformin + SU than for those prescribed metformin + OHA. This adds to the evidence that long-term and health economic outcomes should be considered in treatment decisions for patients with type 2 diabetes.
Collapse
Affiliation(s)
- H Strongman
- Clinical Practice Research Datalink, MHRA, London, UK
| | - K D'Oca
- Merck Sharp & Dohme Ltd, Hoddesdon, UK
| | | | - R Das
- Merck Sharp & Dohme Ltd, Hoddesdon, UK
| |
Collapse
|
217
|
Dawson AZ, Walker RJ, Campbell JA, Egede LE. Effect of perceived racial discrimination on self-care behaviors, glycemic control, and quality of life in adults with type 2 diabetes. Endocrine 2015; 49:422-8. [PMID: 25414069 PMCID: PMC4440842 DOI: 10.1007/s12020-014-0482-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study used a large sample size of black and white patients with type 2 diabetes to investigate the influence of perceived racial discrimination on biologic measures (glycemic control, blood pressure, and LDL cholesterol), the mental component of quality of life (MCS), and health behaviors known to improve diabetes outcomes. METHODS 602 patients were recruited from two adult primary care clinics in the southeastern United States. Linear regression models were used to assess the associations between perceived racial discrimination, self-care, clinical outcomes, MCS, adjusting for relevant covariates. Race-stratified models were conducted to examine differential associations by race. RESULTS The mean age was 61 years, with 64.9 % non-Hispanic black, and 41.6 % earning less than $20,000 annually. Perceived discrimination was significantly negatively associated with MCS (β = -0.56, 95 % CI -0.90, 0.23), general diet (β = -0.37, CI -0.65, -0.08), and specific diet (β = -0.25, CI -0.47, -0.03). In African Americans, perceived discrimination was significantly associated with higher systolic blood pressure (β = 10.17, CI 1.13, -19.22). In Whites, perceived discrimination was significantly associated with lower MCS (β = -0.51, CI -0.89, -0.14), general diet (β = -0.40, CI -0.69, -0.99), specific diet (β = -0.25, CI -0.47, -0.03), and blood glucose testing (β = -0.43, CI -0.80, -0.06). CONCLUSIONS While no association was found with biologic measures, perceived discrimination was associated with health behaviors and the MCS. In addition, results showed a difference in influence of perceived discrimination by race.
Collapse
Affiliation(s)
- Aprill Z. Dawson
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC
| | - Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
218
|
O'Brien MJ, Perez A, Alos VA, Whitaker RC, Ciolino JD, Mohr DC, Ackermann RT. The feasibility, acceptability, and preliminary effectiveness of a Promotora-Led Diabetes Prevention Program (PL-DPP) in Latinas: a pilot study. DIABETES EDUCATOR 2015; 41:485-94. [PMID: 26023095 DOI: 10.1177/0145721715586576] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this pilot study is to test the feasibility, acceptability, and preliminary effectiveness of a Promotora-Led Diabetes Prevention Program (PL-DPP) in Hispanic women (Latinas). METHODS Twenty Latina adults with prediabetes were enrolled in this single-arm pilot trial of PL-DPP. Participants underwent a year-long lifestyle intervention consisting of 24 sessions divided into 14 weekly core sessions and 10 post-core sessions offered either biweekly or monthly. Each session was led by a promotora in Spanish. The primary outcome was weight change over the 12-month study period. RESULTS The study participants were socioeconomically challenged, middle-aged Latinas with limited access to health care. Eighteen participants (90%) completed at least 12 sessions, and 1 was lost to follow-up. Overall, participants reported high levels of satisfaction with PL-DPP. At 12 months, the participants achieved a mean weight loss of 10.8 pounds, which corresponded to 5.6% of initial body weight. Significant pre-post reductions in waist circumference, diastolic blood pressure, LDL cholesterol, and insulin levels were also observed. Modest reductions in A1C and fasting plasma glucose were not significant. CONCLUSIONS The PL-DPP demonstrated feasibility, acceptability, and preliminary effectiveness in a high-risk population of Latinas. Future research examining this intervention in a randomized clinical trial should explore factors impacting its effects using both qualitative and quantitative methods.
Collapse
Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr O'Brien, Dr Ackermann),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr O'Brien, Dr Ackermann),Center for Obesity Research and Education, Temple University, Philadelphia, PA (Dr O'Brien, Ms Perez, Dr Alos, Dr Whitaker),Puentes de Salud Health and Wellness Center, Philadelphia, PA, USA (Dr O'Brien, Ms Perez, Dr Alos)
| | - Alberly Perez
- Center for Obesity Research and Education, Temple University, Philadelphia, PA (Dr O'Brien, Ms Perez, Dr Alos, Dr Whitaker),Puentes de Salud Health and Wellness Center, Philadelphia, PA, USA (Dr O'Brien, Ms Perez, Dr Alos)
| | - Victor A Alos
- Center for Obesity Research and Education, Temple University, Philadelphia, PA (Dr O'Brien, Ms Perez, Dr Alos, Dr Whitaker),Department of Public Health, Temple University, Philadelphia, PA, USA (Dr Alos, Dr Whitaker),Puentes de Salud Health and Wellness Center, Philadelphia, PA, USA (Dr O'Brien, Ms Perez, Dr Alos)
| | - Robert C Whitaker
- Center for Obesity Research and Education, Temple University, Philadelphia, PA (Dr O'Brien, Ms Perez, Dr Alos, Dr Whitaker),Department of Public Health, Temple University, Philadelphia, PA, USA (Dr Alos, Dr Whitaker)
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Ciolino, Dr Mohr)
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Ciolino, Dr Mohr)
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr O'Brien, Dr Ackermann),Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr O'Brien, Dr Ackermann)
| |
Collapse
|
219
|
Skinner JS, Poe B, Hopper R, Boyer A, Wilkins CH. Assessing the effectiveness of pharmacist-directed medication therapy management in improving diabetes outcomes in patients with poorly controlled diabetes. DIABETES EDUCATOR 2015; 41:459-65. [PMID: 26009557 DOI: 10.1177/0145721715587563] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to compare medication adherence rates and type 2 diabetes mellitus (T2DM) health outcomes in a sample of underserved patients with suboptimally controlled T2DM (A1C >7%) who had received pharmacist-directed medication therapy management (MTM) to those who had not received MTM. METHODS A retrospective review of 100 patient records was conducted. For the MTM group, a pharmacist engaged patients in patient-centered services to optimize therapeutic outcomes. Non-MTM patients received usual care. Outcomes were A1C, medication adherence, blood pressure, lipids, and creatinine. Group comparisons on clinical outcomes were analyzed before and after matching MTM and non-MTM patients on demographic characteristics. RESULTS Before matching, the MTM group had a higher rate of medication adherence than the non-MTM group. The A1C levels were lower in the MTM group compared to the non-MTM group. Similarly, low-density lipoprotein (LDL) cholesterol was lower in the MTM group compared to the non-MTM group. After matching, medication adherence rate remained higher in the MTM group than the non-MTM group. Similarly, A1C levels remained lower in the MTM group than the non-MTM group. CONCLUSIONS There is a paucity of research focused on behavioral interventions for improving health outcomes in underserved communities. Our results advance the existing literature by demonstrating a positive association between pharmacist-directed MTM, medication adherence, and glycemic control in a sample of underserved patients with suboptimally controlled T2DM. A prospective pharmacy intervention and examination of long-term effects of MTM on medication adherence and T2DM health outcomes in this population is warranted.
Collapse
Affiliation(s)
- Jeannine S Skinner
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Skinner, Mr Poe, Dr Boyer, Dr Wilkins)
| | - Brett Poe
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Skinner, Mr Poe, Dr Boyer, Dr Wilkins)
| | - Rebecca Hopper
- Saint Thomas Family Center, West, Nashville, Tennessee (Dr Hopper)
| | - Alaina Boyer
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Skinner, Mr Poe, Dr Boyer, Dr Wilkins)
| | - Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Skinner, Mr Poe, Dr Boyer, Dr Wilkins),Meharry Medical College, Nashville, Tennessee (Dr Wilkins)
| |
Collapse
|
220
|
Abstract
BACKGROUND The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. OBJECTIVE To identify military-related and health-related characteristics associated with unemployment in women Veterans. RESEARCH DESIGN AND SUBJECTS Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. MEASURES Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. ANALYSIS The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. RESULTS Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. CONCLUSIONS Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.
Collapse
|
221
|
Dalsgaard EM, Skriver MV, Sandbaek A, Vestergaard M. Socioeconomic position, type 2 diabetes and long-term risk of death. PLoS One 2015; 10:e0124829. [PMID: 25942435 PMCID: PMC4420496 DOI: 10.1371/journal.pone.0124829] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/19/2015] [Indexed: 11/19/2022] Open
Abstract
Background Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; however, little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account. Methods We conducted a population-based cohort study of all Danish citizens aged 40-69 years with no history of diabetes during 2001-2006 (N=2,330,206). The cohort was identified using nationwide registers, and it was followed for up to 11 years (mean follow-up was 9.5 years (SD: 2.6)). We estimated the age-standardised mortality rate (MR) and performed Poisson regression to estimate the mortality-rate-ratio (MRR) by educational level, income and cohabiting status among people with and without type 2 diabetes. Results We followed 2,330,206 people for 22,971,026 person-years at risk and identified 139,681 individuals with type 2 diabetes. In total, 195,661 people died during the study period; 19,959 of these had type 2 diabetes. The age-standardised MR increased with decreasing SEP both for people with and without diabetes. Type 2 diabetes and SEP both had a strong impact on the overall mortality; the combined effect of type 2 diabetes and SEP on mortality was additive rather than multiplicative. Compared to women without diabetes and in the highest income quintile, the MRR’s were 2.8 (95%CI 2.6, 3.0) higher for women with type 2 diabetes in the lowest income quintile, while diabetes alone increased the risk of mortality 2.0 (95%CI 1.9, 2.2) times and being in the lowest income quintile without diabetes 1.8 (95%CI 1.7,1.9) times after adjusting for comorbidity. For men, the MRR’s were 2.7 (95%CI 2.5,2.9), 1.9 (95%CI 1.8,2.0) and 1.8 (95%CI 1.8,1.9), respectively. Conclusion Both Type 2 diabetes and SEP were associated with the overall mortality. The relation between type 2 diabetes, SEP, and all-cause mortality was only partly explained by comorbidity.
Collapse
Affiliation(s)
- Else-Marie Dalsgaard
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
- * E-mail:
| | - Mette V. Skriver
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark
| | - Annelli Sandbaek
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
| | - Mogens Vestergaard
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
- Department of Public Health, Section for General Practice and Research Unit for General Practice, Aarhus University, Denmark
| |
Collapse
|
222
|
Ervasti J, Virtanen M, Pentti J, Lallukka T, Tinghög P, Kjeldgard L, Mittendorfer-Rutz E, Alexanderson K. Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden. Am J Public Health 2015; 105:e22-9. [PMID: 25879142 DOI: 10.2105/ajph.2015.302646] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis. METHODS This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009. RESULTS Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability. CONCLUSIONS Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.
Collapse
Affiliation(s)
- Jenni Ervasti
- Jenni Ervasti, Marianna Virtanen, Jaana Pentti, and Tea Lallukka are with the Finnish Institute of Occupational Health, Helsinki and Turku, Finland. Petter Tinghög, Linnea Kjeldgård, Ellenor Mittendorfer-Rutz, and Kristina Alexanderson are with the Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
223
|
Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called “EMPATHy” that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. Methods/Design The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be “coaches” to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a “contextualized plan of care” (i.e., a plan of care that addresses a barrier to medication adherence in the patient’s daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. Discussion The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. Trial registration ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
Collapse
Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
| |
Collapse
|
224
|
Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called "EMPATHy" that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. METHODS/DESIGN The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be "coaches" to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a "contextualized plan of care" (i.e., a plan of care that addresses a barrier to medication adherence in the patient's daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. DISCUSSION The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. TRIAL REGISTRATION ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
Collapse
Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
| |
Collapse
|
225
|
Brice Reynolds D, Walker RJ, Campbell JA, Egede LE. Differential effect of race, education, gender, and language discrimination on glycemic control in adults with type 2 diabetes. Diabetes Technol Ther 2015; 17:243-7. [PMID: 25549154 PMCID: PMC4365429 DOI: 10.1089/dia.2014.0285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. PATIENTS AND METHODS Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. RESULTS The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. CONCLUSIONS Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.
Collapse
Affiliation(s)
- D. Brice Reynolds
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston Veterans Affairs Health Services Research & Development Centers of Innovation, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center, Charleston Veterans Affairs Health Services Research & Development Centers of Innovation, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
226
|
Ke C, Sohal P, Qian H, Quan H, Khan NA. Diabetes in the young: a population-based study of South Asian, Chinese and White people. Diabet Med 2015; 32:487-96. [PMID: 25472769 DOI: 10.1111/dme.12657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/16/2022]
Abstract
AIMS Rates of diabetes mellitus in the young have not been quantified on a population level, particularly in South Asian and Chinese populations, which bear high rates of diabetes. We determined the incidence of diabetes (Type 2 diabetes and diabetes using insulin only) and rates of hospitalizations among South Asian, Chinese and White people aged 5-29 years with newly diagnosed diabetes. METHODS People with newly diagnosed diabetes (1997-2006) in British Columbia, Canada were identified using population-based administrative data and pharmacy databases. Age-standardized incidence rates were calculated for people with diabetes prescribed insulin only and those with Type 2 diabetes. They were followed for up to 8 years for all hospitalizations and diabetes-related complications. RESULTS There were 712 South Asians, 498 Chinese and 6176 White people aged 5-29 years with diabetes. Most youth with diabetes had Type 2 diabetes (South Asian 86.4%; Chinese 87.1% and White 61.8%). The incidence of diabetes on insulin only was highest in White people compared with the other groups. The incidence of Type 2 diabetes was highest in South Asians, particularly in 20-29-year-olds, with rates 2.2 times that of White people and 3.1 times that of Chinese people. Hospitalization and diabetes-related complications were uncommon in all groups. CONCLUSION The incidence of Type 2 diabetes is higher than previously estimated among youth and is now surpassing diabetes on insulin only. Significant reductions in Type 2 diabetes screening ages in South Asians need to be considered and prevention efforts are urgently required in childhood and adolescence. Global estimates need to consider the epidemic of Type 2 diabetes in the young.
Collapse
Affiliation(s)
- C Ke
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | |
Collapse
|
227
|
Hwang J, Rudnisky C, Bowen S, Johnson JA. Socioeconomic factors associated with visual impairment and ophthalmic care utilization in patients with type II diabetes. Can J Ophthalmol 2015; 50:119-26. [DOI: 10.1016/j.jcjo.2014.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/18/2014] [Accepted: 11/22/2014] [Indexed: 10/23/2022]
|
228
|
Chen PC, Tsai CY, Woung LC, Lee YC. Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach. Int J Equity Health 2015; 14:31. [PMID: 25889800 PMCID: PMC4377057 DOI: 10.1186/s12939-015-0160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Literature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan. METHODS This study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan's National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models. RESULTS A total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010-2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization. CONCLUSIONS Our results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.
Collapse
Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan. .,Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan.
| | - Ching-Yao Tsai
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| |
Collapse
|
229
|
Nwanyanwu KH, Newman-Casey PA, Gardner TW, Lim JI. Beyond HbA 1c: Environmental Risk Factors for Diabetic Retinopathy. ACTA ACUST UNITED AC 2015; 6. [PMID: 26973797 PMCID: PMC4785841 DOI: 10.4172/2155-9570.1000405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diabetic retinopathy affects 4.2 million people in the United States and is the leading cause of blindness in working-aged people. As the prevalence of diabetes continues to rise, cost-effective interventions to decrease blindness from diabetic retinopathy will be paramount. While HbA1c and duration of disease are known risk factors, they account for only 11% of the risk of developing microvascular complications from the disease. The assessment of environmental risk factors for diabetic eye disease allows for the determination of modifiable population-level challenges that may be addressed to facilitate the end of blindness from diabetes.
Collapse
Affiliation(s)
| | | | | | - Jennifer I Lim
- University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
230
|
Cosson E, Bihan H, Reach G, Vittaz L, Carbillon L, Valensi P. Psychosocial deprivation in women with gestational diabetes mellitus is associated with poor fetomaternal prognoses: an observational study. BMJ Open 2015; 5:e007120. [PMID: 25748416 PMCID: PMC4360844 DOI: 10.1136/bmjopen-2014-007120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM). DESIGN Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012. SETTING Four largest maternity units in the northeastern suburban area of Paris. PARTICIPANTS The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. MAIN OUTCOME MEASURE Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia). RESULTS Psychosocial deprivation (EPICES score ≥30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01). CONCLUSIONS In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants.
Collapse
Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
| | - Hélène Bihan
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
- Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France
| | - Gérard Reach
- Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France
| | - Laurence Vittaz
- Department of Endocrinology-Diabetology, Ballanger Hospital, Aulnay-Sous-Bois, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynecology, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
| |
Collapse
|
231
|
Dupre ME, Silberberg M, Willis JM, Feinglos MN. Education, glucose control, and mortality risks among U.S. older adults with diabetes. Diabetes Res Clin Pract 2015; 107:392-9. [PMID: 25649910 DOI: 10.1016/j.diabres.2014.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/09/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
AIMS Studies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A1c (HbA1c), and subsequent mortality in adults with diabetes. METHODS Prospective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n=3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA1c control (<7.0% [53 mmol/mol] vs. ≥7.0% [53 mmol/mol]). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA1c level with sequential adjustments for contributing risk factors. RESULTS Mortality risks associated with HbA1c≥7.0% [53 mmol/mol] were significantly greater in lower-educated adults than higher-educated adults (P<0.001). We found that the hazard ratios (HR) associated with HbA1c ≥7.0% [53 mmol/mol] were highest among low-educated adults (HR=2.18, 95% CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. CONCLUSIONS Educational differences in HbA1c control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes.
Collapse
Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA; Department of Sociology, Duke University, Durham, NC, USA.
| | - Mina Silberberg
- Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Janese M Willis
- Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Mark N Feinglos
- Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, NC, USA
| |
Collapse
|
232
|
Smalls BL, Gregory CM, Zoller JS, Egede LE. Direct and indirect effects of neighborhood factors and self-care on glycemic control in adults with type 2 diabetes. J Diabetes Complications 2015; 29:186-91. [PMID: 25483848 DOI: 10.1016/j.jdiacomp.2014.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 12/31/2022]
Abstract
AIM To determine whether neighborhood factors have direct or indirect effects, via self-care behaviors on glycemic control. METHODS Adult patients with type 2 diabetes were recruited from an academic medical center and Veterans Affairs Medical Center in the southeastern United States. Confirmatory factor analysis was used to create latent variables for neighborhood factors and diabetes self-care behavior. Structural equation modeling was used to test direct and indirect effects between neighborhood factors and glycemic control as assessed by HbA1c levels. RESULTS CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood aesthetics) and one latent variable diabetes self-care. We found that social support (β=0.28, z=4.86, p<0.001) and access to healthy foods (β=-0.17, z=-2.95, p=0.003) had direct effects on self-care; self-care (β=-0.15, z=-2.48, p=0.013) and neighborhood aesthetics (β=0.12, z=2.19, p=0.03) had direct effects on glycemic control; while social support (β=-0.04, z=-2.26, p=0.02) had an indirect effect on glycemic control via self-care. CONCLUSION This study showed that self-care behaviors and neighborhood aesthetics have direct effects on glycemic control, social support and access to health foods had direct effects on self-care, and social support had an indirect effect on glycemic control via self-care.
Collapse
Affiliation(s)
- Brittany L Smalls
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US; Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, US.
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US.
| | - James S Zoller
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US; Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave., MSC 960, Charleston, SC 29425, US.
| | - Leonard E Egede
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave., MSC 960, Charleston, SC 29425, US; Division of General Internal Medicine Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, RT 12th Floor, P.O. Box 250591 Charleston, SC 29425, US; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, 109 Bee Street, Charleston, SC 29401, US.
| |
Collapse
|
233
|
Adams AS, Banerjee S, Ku CJ. Medication adherence and racial differences in diabetes in the USA: an update. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/dmt.14.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
234
|
Peykari N, Djalalinia S, Qorbani M, Sobhani S, Farzadfar F, Larijani B. Socioeconomic inequalities and diabetes: A systematic review from Iran. J Diabetes Metab Disord 2015; 14:8. [PMID: 25806357 PMCID: PMC4372329 DOI: 10.1186/s40200-015-0135-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/07/2015] [Indexed: 01/04/2023]
Abstract
Socioeconomic factor is a determinant of health may contribute to diabetes. We conducted a systematic review to summarizing evidences on associations between socioeconomic factors and diabetes in Iranian population. We systematically searched international databeses; ISI, PubMed/Medline, Scopus, and national databases Iranmedex, Irandoc, and Scientific Information Database (SID) to retrieve relevant articles to socioeconomic factors and diabetes without limitation on time. All identified articles were screened, quality assessed and data extracted by two authors independently. From 74 retrieved articles, 15 cases were relevant. We found increased diabetes prevalence among female sex, over 50 years' old age, illiterate population, retired status, unemployed, urban residents, and low economic status. There was a negative association between social capital and diabetes control. Diabetes complications were more frequent in upper age group, higher education levels and low income populations. Socioeconomic factors were associated with diabetes that leads to inequality. Improving modifiable factors through priority based interventions helps to diabetes prevention and control.
Collapse
Affiliation(s)
- Niloofar Peykari
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 4th floor, No 4, Ostad Nejatollahi St, Enqelab Ave, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 5th floor, Shariati Hospital, Kargar St, Tehran, Iran.,Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 4th floor, No 4, Ostad Nejatollahi St, Enqelab Ave, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 5th floor, Shariati Hospital, Kargar St, Tehran, Iran.,Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mostafa Qorbani
- School of Medicine, Community Medicine Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Sahar Sobhani
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 4th floor, No 4, Ostad Nejatollahi St, Enqelab Ave, Tehran, Iran
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 4th floor, No 4, Ostad Nejatollahi St, Enqelab Ave, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 5th floor, Shariati Hospital, Kargar St, Tehran, Iran
| |
Collapse
|
235
|
Flatz A, Casillas A, Stringhini S, Zuercher E, Burnand B, Peytremann-Bridevaux I. Association between education and quality of diabetes care in Switzerland. Int J Gen Med 2015; 8:87-92. [PMID: 25759596 PMCID: PMC4346359 DOI: 10.2147/ijgm.s77139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. PATIENTS AND METHODS Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. RESULTS Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]). CONCLUSION Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.
Collapse
Affiliation(s)
- Aline Flatz
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Alejandra Casillas
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Zuercher
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | |
Collapse
|
236
|
Smalls BL, Walker RJ, Bonilha HS, Campbell JA, Egede LE. Community Interventions to Improve Glycemic Control in African Americans with Type 2 Diabetes: A Systemic Review. Glob J Health Sci 2015; 7:171-82. [PMID: 26156923 PMCID: PMC4803865 DOI: 10.5539/gjhs.v7n5p171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/06/2015] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. METHODS Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. RESULTS Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. CONCLUSION In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches.
Collapse
|
237
|
Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes. Diabetes Technol Ther 2015; 17:80-7. [PMID: 25361382 PMCID: PMC4322090 DOI: 10.1089/dia.2014.0166] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. SUBJECTS AND METHODS Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. RESULTS Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ(2)(275)=450.07, P<0.001, R(2)=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). CONCLUSIONS This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.
Collapse
Affiliation(s)
- Rebekah J. Walker
- Health Equity and Rural Outreach Innovation Center, Charleston Veterans Affairs Health Services Research and Development Service Center of Innovation, Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Charleston Veterans Affairs Health Services Research and Development Service Center of Innovation, Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina
- Division of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Health Equity and Rural Outreach Innovation Center, Charleston Veterans Affairs Health Services Research and Development Service Center of Innovation, Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
238
|
Kim SR, Han K, Choi JY, Ersek J, Liu J, Jo SJ, Lee KS, Yim HW, Lee WC, Park YG, Lee SH, Park YM. Age- and sex-specific relationships between household income, education, and diabetes mellitus in Korean adults: the Korea National Health and Nutrition Examination Survey, 2008-2010. PLoS One 2015; 10:e0117034. [PMID: 25622031 PMCID: PMC4306546 DOI: 10.1371/journal.pone.0117034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/17/2014] [Indexed: 02/03/2023] Open
Abstract
Background To investigate the effects of age and sex on the relationship between socioeconomic status (SES) and the prevalence and control status of diabetes mellitus (DM) in Korean adults. Methods Data came from 16,175 adults (6,951 men and 9,227 women) over the age of 30 who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. SES was measured by household income or education level. The adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) for the prevalence or control status of diabetes were calculated using multiple logistic regression analyses across household income quartiles and education levels. Results The household income-DM and education level-DM relationships were significant in younger age groups for both men and women. The adjusted ORs and 95% CI for diabetes were 1.51 (0.97, 2.34) and 2.28 (1.29, 4.02) for the lowest vs. highest quartiles of household income and education level, respectively, in women younger than 65 years of age (both P for linear trend < 0.05 with Bonferroni adjustment). The adjusted OR and 95% CI for diabetes was 2.28 (1.53, 3.39) for the lowest vs. highest quartile of household income in men younger than 65 (P for linear trend < 0.05 with Bonferroni adjustment). However, in men and women older than 65, no associations were found between SES and the prevalence of DM. No significant association between SES and the status of glycemic control was detected. Conclusions We found age- and sex-specific differences in the relationship of household income and education with the prevalence of DM in Korea. DM preventive care is needed for groups with a low SES, particularly in young or middle-aged populations.
Collapse
Affiliation(s)
- So-Ra Kim
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Young Choi
- Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - Jennifer Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
| | - Junxiu Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
| | - Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Chul Lee
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St.Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail: (YMP); (SHL)
| | - Yong-Moon Park
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail: (YMP); (SHL)
| |
Collapse
|
239
|
Torenholt R, Varming A, Engelund G, Vestergaard S, Møller BL, Pals RAS, Willaing I. Simplicity, flexibility, and respect: preferences related to patient education in hardly reached people with type 2 diabetes. Patient Prefer Adherence 2015; 9:1581-6. [PMID: 26604711 PMCID: PMC4639536 DOI: 10.2147/ppa.s91408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Individuals with lower income and less education are two to four times more likely to develop diabetes than more advantaged individuals. In response to this, there is a need for developing health promotion activities targeting hardly reached populations. The aim of this study was to examine the perspectives of hardly reached people with type 2 diabetes on patient education, focusing on their wishes and needs regarding format and approach. Data were collected through qualitative interviews with nine individuals with type 2 diabetes with little or no education and characterized as hardly reached patients by health professionals. Interviews were transcribed verbatim and analyzed according to systematic text condensation. We identified four main categories of preferences for patient education: 1) flexibility related to start time, duration, and intensity; 2) simple and concrete education tools, with regard to design and extent; 3) being together, related to meeting people in a similar situation; and 4) respectful educators, related to constructive patient-educator relationships. Insights into the preferences of hardly reached people with diabetes can contribute to the development of appropriately tailored patient education for this patient group.
Collapse
Affiliation(s)
- Rikke Torenholt
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
| | - Annemarie Varming
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
| | - Gitte Engelund
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
| | | | | | - Regitze Anne Saurbrey Pals
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
- Correspondence: Regitze Anne Saurbrey Pals, Steno Diabetes Center A/S, Niels Steensens Vej 8, 2820 Gentofte, Denmark, Tel +45 30 794 195, Email
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
| |
Collapse
|
240
|
Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling. PATIENT EDUCATION AND COUNSELING 2015; 98:34-40. [PMID: 25455793 PMCID: PMC4314329 DOI: 10.1016/j.pec.2014.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/17/2014] [Accepted: 10/04/2014] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To develop and test latent variables of the social determinants of health that influence diabetes self-care. METHODS 615 adults with type 2 diabetes were recruited from two adult primary care clinics in the southeastern United States. Confirmatory factor analyses (CFA) identified the latent factors underlying socioeconomic determinants, psychosocial determinants, and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling (SEM) investigated the relationship between determinants and self-care. RESULTS Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support and social status. The initial model (chi2(254) = 388.04, p < 0.001, RMSEA = 0.03, CFI = 0.98) showed that lower psychological distress (r = -0.13, p = 0.019), higher social support (r = 0.15, p = 0.008), and higher self-efficacy (r = 0.47, p < 0.001) were significantly related to diabetes self-care. Social status was not significantly related to self-care (r = 0.003, p = 0.952). In the trimmed model (chi2(189) = 211.40, p = 0.126, RMSEA = 0.01, CFI = 0.99) lower psychological distress (r = -0.13, p = 0.016), higher social support (r = 0.15, p = 0.007), and higher self-efficacy (r = 0.47, p < 0.001) remained significantly related to diabetes self-care. CONCLUSION Based on theoretical relationships, three latent factors that measure social determinants of health (psychological distress, social support and self-efficacy) are strongly associated with diabetes self-care. PRACTICE IMPLICATIONS This suggests that social determinants should be taken into account when developing patient self-care goals.
Collapse
Affiliation(s)
- Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
241
|
Relationship between socioeconomic status and quality of life in older adults: a path analysis. Qual Life Res 2014; 24:1697-705. [PMID: 25526722 DOI: 10.1007/s11136-014-0898-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The main objective of this study was to determine the relationship between quality of life, social functioning, depressive symptoms, self-efficacy, physical function, and socioeconomic status (SES) in community-dwelling older adults. METHODS A cross-sectional design was used to examine the relationships. A sample of 193 community-dwelling older adults completed the measurements. Structural equation modeling with full information maximum likelihood in LISREL was used to evaluate the relationships between the latent variables (SES, social functioning, depressive symptoms, self-efficacy, physical function, and quality of life). RESULTS The path analysis exhibited significant effects of SES on physical function, social functioning, depressive symptoms, and self-efficacy (γ = 0.42-0.73), and significant effects in regard to social functioning, depressive symptoms, and self-efficacy on quality of life (γ = 0.27-0.61). There was no direct effect of SES on the quality of life. The model fit indices demonstrated a reasonable fit (χ (2) = 98.3, df = 48, p < 0.001), matching the relative Chi-square criterion and the RMSEA criterion. The model explained 55.5 % of the variance of quality of life. CONCLUSIONS The path analysis indicated an indirect effect of SES on the quality of life by social functioning, depressive symptoms, and self-efficacy in community-dwelling older adults. Physical function did not have a direct effect on the quality of life. To improve the quality of life in older adults, additional focus is required on the socioeconomic psychosocial differences in the community-dwelling older population.
Collapse
|
242
|
Smalls BL, Gregory CM, Zoller JS, Egede LE. Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes. Diabetes Res Clin Pract 2014; 106:435-42. [PMID: 25451904 PMCID: PMC4275065 DOI: 10.1016/j.diabres.2014.09.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/20/2014] [Accepted: 09/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS 615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care. RESULTS Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r=0.28, p<0.001) and access to healthy foods (r=-0.16, p=0.003) were significantly associated with self-care behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07, p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods (r=-0.20, p<0.001) remained significantly associated with self-care behaviors χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0). CONCLUSION This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.
Collapse
Affiliation(s)
- Brittany L Smalls
- Center for Health Organization and Implementation Research (CHOIR), eHealth Quality Enhancement Research Initiative (QUERI), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - James S Zoller
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, United States; Division of General Internal Medicine and Geriatrics, Department of Medicien, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Research Innovation Center (HEROIC), Charleston VA HSR&D COIN, Charleston, SC, United States.
| |
Collapse
|
243
|
Moreno G, Morales LS, Nuñez de Jaimes F, Tseng CH, Isiordia M, Noguera C, Mangione CM. Neighborhood perceptions and health-related outcomes among Latinos with diabetes from a rural agricultural community. J Community Health 2014; 39:1077-84. [PMID: 24599665 PMCID: PMC4156928 DOI: 10.1007/s10900-014-9854-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes [LDL-cholesterol (LDL-c) < 100 mg/dl, AlC < 9.0 %, and blood pressure (BP) < 140/80 mmHg], and body mass index (BMI) < 30 kg/m(2). Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP < 140/80 [Adjusted odds ratio (AOR) = 0.45; 95 % CI 0.22, 0.92], and BMI < 30 (AOR = 0.43; 95 % CI 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP.
Collapse
Affiliation(s)
- Gerardo Moreno
- Department of Family Medicine, UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA,
| | | | | | | | | | | | | |
Collapse
|
244
|
Collier A, Ghosh S, Hair M, Waugh N. Impact of socioeconomic status and gender on glycaemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region. DIABETES & METABOLISM 2014; 41:145-51. [PMID: 25454092 DOI: 10.1016/j.diabet.2014.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS In this cross-sectional study, the aims were to investigate the association of the socioeconomic status and gender on the prevalence of type 1 and 2 diabetes, glycaemic control, cardiovascular risk factors plus the complications of diabetes in a population-based analysis in the county of Ayrshire and Arran, Scotland. METHODS Quality Outcome Framework data was obtained from General Practices in Ayrshire and Arran, Scotland (n=15,351 patients). RESULTS In type 1 diabetes, there was an increasing linear trend in HbA1c across deprivation levels (P<0.01). In type 1 diabetes, obesity in women (P<0.01) and increased non-fasting triglyceride levels in both men and women were associated with deprivation (P<0.05). In type 2 diabetes, there was a significant prevalence trend with deprivation for women (P<0.01) but not with glycaemic control (P=0.12). Smoking, ischaemic heart disease and neuropathy (P<0.01) were all associated with increasing deprivation with gender differences. In type 2 diabetes, reduced HDL cholesterol (P<0.01 both genders), and percentage of people on lipid lowering therapy (men P<0.05; women P<0.01) were associated with deprivation. Smoking, ischaemic heart disease, peripheral vascular disease and neuropathy plus foot ulcers (P<0.05) were all associated with increasing deprivation with gender differences. CONCLUSIONS Socioeconomic status and gender are associated with changes in glycaemic control and cardiovascular risk factors plus complication development in both type 1 and 2 diabetes. The mechanisms are unclear but follow-up of these patients should allow greater understanding.
Collapse
Affiliation(s)
- A Collier
- Department of General Medicine, The Ayr Hospital, NHS Ayrshire & Arran, KA6 6DX, United Kingdom.
| | - S Ghosh
- AMRI Institute of Diabetes and Hormonal Disorders, 38/1A Gariahat Road, 700029 Kolkata, India
| | - M Hair
- Statistics Consultant, NHS Ayrshire & Arran, KA6 6DX, United Kingdom
| | - N Waugh
- Health Sciences, Division of Health Sciences, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| |
Collapse
|
245
|
Yang JJ, Yoon HS, Lee SA, Choi JY, Song M, Han S, Lee JK, Kang D. Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys. Diabet Med 2014; 31:1399-409. [PMID: 24925795 DOI: 10.1111/dme.12525] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/04/2014] [Accepted: 06/09/2014] [Indexed: 12/24/2022]
Abstract
AIMS To examine whether adulthood and/or childhood sex-specific socio-economic disparities are associated with metabolic syndrome and its components in a developed non-Western setting. METHODS Based on the Fourth Korea National Health and Nutrition Examination Surveys, 14 888 people aged ≥ 20 years were analysed to evaluate the effect of adult and childhood socio-economic status on metabolic syndrome. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Logistic regression analyses were conducted to calculate the odds ratios for metabolic syndrome and each component of metabolic syndrome in later life. RESULTS The age-standardized prevalence of metabolic syndrome was 26.6% for men and 21.3% for women. Compared with the highest level of education, men with the lowest education level were significantly less likely to have metabolic syndrome (odds ratio 0.76, 95% CI 0.60-0.96), whereas the opposite association was found in women (odds ratio 3.29, 95% CI 2.45-4.42). Men who were manual labourers and economically inactive had a lower prevalence of metabolic syndrome compared with those with non-manual jobs (odds ratio 0.82, 95% CI 0.69-0.98 and odds ratio 0.79, 95% CI 0.64-0.99, respectively), but the reverse association was observed in women (odds ratio 1.34, 95% CI 1.04-1.73 and odds ratio 1.40, 95% CI 1.09-1.81, respectively). A significant interaction between combined adulthood and childhood socio-economic status on the presence of metabolic syndrome was observed (P < 0.05). CONCLUSIONS Our findings suggest that sex-specific socio-economic disparities in childhood and adulthood have differential effects on the prevalence of metabolic syndrome and its individual components in Korea.
Collapse
Affiliation(s)
- J J Yang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Environmental Medicine, Seoul National University Medical Research Centre, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
246
|
Shah AD, Vittinghoff E, Kandula NR, Srivastava S, Kanaya AM. Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Ann Epidemiol 2014; 25:77-83. [PMID: 25459085 DOI: 10.1016/j.annepidem.2014.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In this study, we aim to elucidate the role of sociodemographic, lifestyle, and cultural factors in prediabetes and diabetes in South Asian immigrants to the United States, a population at high risk of type II diabetes. METHODS We performed a cross-sectional analysis of a community-based cohort of 899 South Asians without known cardiovascular disease from the Mediators of Atherosclerosis in South Asians Living in America study. Glycemic status was determined by fasting glucose, 2-hour postchallenge glucose, and use of diabetes medication. We used multinomial logistic regression models to estimate the independent associations of sociodemographic, lifestyle, and cultural factors with prediabetes and diabetes, adjusting for confounders identified using directed acyclic graphs. RESULTS Approximately 33% of participants had prediabetes and 25% had diabetes. In multivariate analyses, an independent correlate of prediabetes was low exercise. Additional covariates associated with diabetes included lower family income, less education, high chronic psychological burden score, and greater time spent watching television; and fasting monthly or annually was inversely associated with diabetes prevalence. CONCLUSIONS We found several modifiable risk factors associated with prediabetes and diabetes that may help guide diabetes prevention interventions for South Asian immigrants to the United States.
Collapse
Affiliation(s)
- Arti D Shah
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL
| | - Shweta Srivastava
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Alka M Kanaya
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| |
Collapse
|
247
|
Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Relationship between social determinants of health and processes and outcomes in adults with type 2 diabetes: validation of a conceptual framework. BMC Endocr Disord 2014; 14:82. [PMID: 25298071 PMCID: PMC4203970 DOI: 10.1186/1472-6823-14-82] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to empirically validate a conceptual framework and elucidate the pathways linking social determinants of health to outcomes in individuals with type 2 diabetes. METHODS 615 adults were recruited from adult primary care clinics in the southeastern United States. The model was estimated using path analysis to determine if socioeconomic (education, employment, income) and psychosocial (fatalism, self-efficacy, depression, diabetes distress, serious psychological distress, social support, and perceived stress) factors would independently predict glycemic control or be associated with mediator/moderators of self-care, access to care, and processes of care. Covariates were gender, age, race and health literacy. RESULTS The final model (chi2 (15) = 17.68, p = 0.28; RMSEA = 0.02, CFI = 0.99) showed lower glycemic control was directly associated with less hours worked (r = 0.13, p = 0.002), more fatalistic attitudes (r = -0.09, p = 0.03), more self-efficacy (r = -0.30, p < 0.001), and less diabetes distress (r = 0.12, p = 0.03), with the majority of total effects being direct. Significant paths associated self-care with diabetes distress (r = -0.14, p = 0.01) and perceived stress (r = -0.15, p = .001); access to care with income (r = 0.08, p = 0.03), diabetes distress (r = -0.21, p < 0.001) and social support (r = 0.08, p = 0.03); and processes of care with income (r = -0.11, p = 0.03), social support (r = 0.10, p = 0.04), and perceived stress (r = 0.10, p = 0.04). The paths explained 76% of the variance in the model. CONCLUSIONS Consistent with the conceptual framework, social determinants were associated with glycemic control through a direct association and mediators/moderators of self-care, access to care and processes of care. This study provides the first validation of a conceptual framework for the relationship between socioeconomic and psychological components of social determinants of health and diabetes outcomes.
Collapse
Affiliation(s)
- Rebekah J Walker
- />Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC USA
- />Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC USA
- />Department of Health Science and Research, Medical University of South Carolina, Charleston, SC USA
| | - Mulugeta Gebregziabher
- />Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC USA
- />Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Bonnie Martin-Harris
- />Department of Health Science and Research, Medical University of South Carolina, Charleston, SC USA
- />Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC USA
| | - Leonard E Egede
- />Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC USA
- />Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280, PO Box 250593, Charleston, SC USA
- />Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC USA
| |
Collapse
|
248
|
O'Neil A, Williams ED, Browne JL, Horne R, Pouwer F, Speight J. Associations between economic hardship and markers of self-management in adults with type 2 diabetes: results from Diabetes MILES - Australia. Aust N Z J Public Health 2014; 38:466-72. [PMID: 24750399 DOI: 10.1111/1753-6405.12153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/01/2013] [Accepted: 09/01/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours. METHODS Cross-sectional data from a subset of the Diabetes MILES - Australia study were used (n=915). The Economic Hardship Questionnaire was used to assess hardship. Outcomes included: healthy eating and physical activity (Diabetes Self-Care Inventory - Revised), medication-taking behaviour (Medication Adherence Rating Scales) and frequency of self-monitoring of blood glucose (SMBG). Regression modelling was used to explore the respective relationships. RESULTS Greater economic hardship was significantly associated with sub-optimal medication-taking (Coefficient: -0.86, 95%CI -1.54, -0.18), and decreased likelihood of regular physical activity (Odds Ratio: 0.47, 0.29, 0.77). However, after adjustments for a range of variables, these relationships did not hold. Being employed and higher depression levels were significantly associated with less-frequent SMBG, sub-optimal medication-taking and less-regular healthy eating. Engaging in physical activity was strongly associated with healthy eating. CONCLUSIONS Employment, older age and depressive symptoms, not economic hardship, were commonly associated with diabetes self-management. IMPLICATIONS Work-based interventions that promote T2DM self-management in younger, working populations that focus on negative emotions may be beneficial.
Collapse
Affiliation(s)
- Adrienne O'Neil
- IMPACT Strategic Research Centre, Deakin University, Victoria; School of Public Health and Preventive Medicine, Monash University, Victoria
| | | | | | | | | | | |
Collapse
|
249
|
Morgan CL, Mukherjee J, Jenkins-Jones S, Holden SE, Currie CJ. Combination therapy with metformin plus sulphonylureas versus metformin plus DPP-4 inhibitors: association with major adverse cardiovascular events and all-cause mortality. Diabetes Obes Metab 2014; 16:977-83. [PMID: 24762119 DOI: 10.1111/dom.12306] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/02/2014] [Accepted: 04/18/2014] [Indexed: 12/25/2022]
Abstract
AIMS To compare the risk of major adverse cardiovascular events (MACE) and mortality for combination therapies with metformin and either sulphonylurea (SU) or dipeptidyl peptidase-4 inhibitor (DPP-4i). METHODS Data were from the UK Clinical Practice Research Datalink (CPRD). Patients with type 2 diabetes were selected if initiated with combination therapies comprising metformin plus SU or DPP-4i 2007-2012. The co-primary endpoints were all-cause mortality and MACE (myocardial infarction or stroke). Times to endpoints were compared using Cox proportional hazards models. Additional analyses were performed on subsets matched directly on key characteristics and by propensity score. RESULTS A total of 33 983 patients were prescribed SU and 7864 DPP-4i, and 5447 patients in each cohort could be matched directly and 6901 by propensity score. In the main analysis, there were 716 MACE events and 1217 deaths. Crude event rates for MACE were 11.3 events per 1000 person-years (pkpy) for SU, versus 5.3 pkpy for DPP-4i. For all-cause mortality, rates were 16.9 versus 7.3 pkpy, respectively. Following adjustment, there was a significant increase in the adjusted hazard ratio (aHR) for all-cause mortality in those exposed to SU across all analytical models: aHR = 1.357 (95% CI 1.076-1.710) for all subjects, 1.850 (1.245-2.749) directly matched and 1.497 (1.092-2.052) propensity-matched. For MACE, aHR was 1.710 (1.280-2.285) for all subjects, 1.323 (0.832-2.105) directly matched and 1.547 (1.076-2.225) propensity-matched. CONCLUSIONS There was a reduction in all-cause mortality for patients treated with metformin combined with DPP-4i versus metformin plus SU, and a similar trend for MACE.
Collapse
Affiliation(s)
- C Ll Morgan
- Global Epidemiology, Pharmatelligence, Cardiff, UK
| | | | | | | | | |
Collapse
|
250
|
Pilot S, Cohen R, Reach G, Cosson E, Le Clesiau H, Hercberg S, Bihan H. Food insecurity in French patients with diabetes. DIABETES & METABOLISM 2014; 40:314-316. [PMID: 24679595 DOI: 10.1016/j.diabet.2014.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Affiliation(s)
- S Pilot
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - R Cohen
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - G Reach
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 93143 Bondy, France; UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France
| | - H Le Clesiau
- Centre d'Examens de Santé de la Caisse Primaire d'Assurance Maladie de Seine-Saint-Denis, 93009 Bobigny, France
| | - S Hercberg
- UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France
| | - H Bihan
- Department of Endocrinology, Diabetology, Metabolic Disease, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, 127, route de Stalingrad, 93009 Bobigny, France; UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, 93009 Bobigny, France.
| |
Collapse
|