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Anim SB, Spurlark R, Turkson-Ocran RA, Bohr N, Soco C, Simonovich SD. A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans. J Racial Ethn Health Disparities 2024; 11:2935-2944. [PMID: 37580438 DOI: 10.1007/s40615-023-01751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.
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Affiliation(s)
- Sandra B Anim
- DePaul University School of Nursing, Chicago, IL, USA
| | | | | | | | - Cheryl Soco
- DePaul University School of Nursing, Chicago, IL, USA
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Racial disparity in the co-occurrence of depression and type 2 diabetes mellitus. An electronic medical record study involving African American and White Caucasian adults from the US. J Affect Disord 2023; 330:173-179. [PMID: 36868390 DOI: 10.1016/j.jad.2023.02.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Depression and diabetes commonly co-exist, however the temporal trends in the bidirectional association of both diseases in different sociodemographic setting has not been explored. We investigated the trends in prevalence and likelihood of having either depression or type 2 diabetes (T2DM) in African American (AA, or black) and White Caucasians (WC, or white). METHODS In this nationwide population-based study, the US Centricity Electronic Medical Records was used to establish cohorts of >2.5 million adults diagnosed with either T2DM or depression between 2006 and 2017. Logistic regression models were used to investigate ethnic differences in: (a) subsequent probability of depression in individuals with T2DM; and (b) subsequent probability of T2DM in individuals with depression; stratified by age and sex. RESULTS A total of 920,771 (15 % black) adults were identified with T2DM and 1,801,679 (10 % black) with depression. AA diagnosed with T2DM were much younger (56 vs. 60 years) and had significantly lower prevalence of depression (17 vs. 28 %). AA diagnosed with depression were slightly younger (46 vs. 48 years) and had significantly higher prevalence of T2DM (21 % vs. 14 %). The prevalence of depression in T2DM increased from 12 % (11, 14) to 23 % (20, 23) in black and 26 (25, 26) to 32 (32, 33) in white. Depressive AA above 50 years recorded the highest adjusted probability of T2DM (men: 6.3 % (5.8, 7.0), women: 6.3 % (5.9, 6.7)), while diabetic white women below 50 years had the highest probability of depression (20.2 % (18.6, 22.0)). No significant ethnic difference in diabetes was observed for younger adults diagnosed with depression: black 3.1 % (2.7, 3.7); white 2.5 % (2.2, 2.7). CONCLUSIONS We have observed significant difference in depression between AA and WC recently diagnosed with diabetes consistent across different demographics. Depression in people with diabetes is increasing with significantly higher values among white women younger than 50 years.
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Hall JM, Chakrabarti C, Mkuu R, Thompson LA, Shenkman EA, Theis RP. The Association of Socioeconomic Vulnerability and Race and Ethnicity With Disease Burden Among Children in a Statewide Medicaid Population. Acad Pediatr 2023; 23:372-380. [PMID: 36122832 DOI: 10.1016/j.acap.2022.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals enrolled in Medicaid have disproportionately worse health outcomes due to challenges related to Social Determinants of Health. We aim to examine the prevalence of 3 childhood conditions (asthma, type 2 diabetes, and attention deficit hyperactivity disorder [ADHD]) in children within the Texas Medicaid system. In order to recognize the layers of vulnerability, we examine prevalence at the intersection of socioeconomic status with race and ethnicity within this economically challenged population. METHODS Children ages 0 to 17 were identified from claims and encounter data for all children enrolled in Texas Medicaid in 2017 for at least 6 months. All children were placed into one of 5 quintiles based on their census tract socioeconomic vulnerability. The Rate Ratio statistical test was employed to identify the statistical significance of the disparity in health outcomes related to higher neighborhood vulnerability within each racial or ethnic group. RESULTS Asthma for each race and ethnicity group was significantly more prevalent in the higher vulnerability census tracts. Increased vulnerability related to significant increase in type 2 diabetes for Hispanic children, but not for other groups. Diagnosed ADHD prevalence was significantly higher in less vulnerable non-Hispanic white children compared to more vulnerable. CONCLUSIONS This study found that even among children who receive Medicaid and are thus economically disadvantaged, socioeconomic vulnerability applies an additional burden within racial and ethnic groups to produce disparities in health-related burden. However, the trend of the relationship varied by race and ethnicity group and health condition.
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Affiliation(s)
- Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla.
| | - Choeeta Chakrabarti
- Department of Anthropology, College of Arts and Sciences, Florida State University (C Chakrabarti), Tallahassee, Fla
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla; Department of Pediatrics, College of Medicine, University of Florida (LA Thompson), Gainesville, Fla
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Relative impact of genetic ancestry and neighborhood socioeconomic status on all-cause mortality in self-identified African Americans. PLoS One 2022; 17:e0273735. [PMID: 36037186 PMCID: PMC9423617 DOI: 10.1371/journal.pone.0273735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Self-identified race/ethnicity is a correlate of both genetic ancestry and socioeconomic factors, both of which may contribute to racial disparities in mortality. Investigators often hold a priori assumptions, rarely made explicit, regarding the relative importance of these factors. We studied 2,239 self-identified African Americans (SIAA) from the Prostate, Lung, Colorectal and Ovarian screening trial enrolled from 1993–1998 and followed prospectively until 2019 or until death, whichever came first. Percent African genetic ancestry was estimated using the GRAF-Pop distance-based method. A neighborhood socioeconomic status (nSES) index was estimated using census tract measures of income, housing, and employment and linked to participant residence in 2012. We used Directed Acyclic Graphs (DAGs) to represent causal models favoring (1) biomedical and (2) social causes of mortality. Hazard ratios were estimated using Cox models adjusted for sociodemographic, behavioral, and neighborhood covariates guided by each DAG. 901 deaths occurred over 40,767 person-years of follow-up. In unadjusted (biomedical) models, a 10% increase in percent African ancestry was associated with a 7% higher rate of all-cause mortality (HR: 1.07, 95% CI: 1.02, 1.12). This effect was attenuated in covariate adjusted (social) models (aHR: 1.01, 95% CI: 0.96, 1.06). Mortality was lower comparing participants in the highest to lowest nSES quintile following adjustment for covariates and ancestry (aHR: 0.74, 95% CI: 0.57, 0.98, Ptrend = 0.017). Higher African ancestry and lower nSES were associated with higher mortality, but African ancestry was not associated with mortality following covariate adjustment. Socioeconomic factors may be more important drivers of mortality in African Americans.
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Farmaki AE, Garfield V, Eastwood SV, Farmer RE, Mathur R, Giannakopoulou O, Patalay P, Kuchenbaecker K, Sattar N, Hughes A, Bhaskaran K, Smeeth L, Chaturvedi N. Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK. Diabetologia 2022; 65:113-127. [PMID: 34668055 PMCID: PMC8660755 DOI: 10.1007/s00125-021-05580-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. METHODS Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40-69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. RESULTS Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis. CONCLUSIONS/INTERPRETATION Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk.
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Affiliation(s)
- Aliki-Eleni Farmaki
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - Victoria Garfield
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Ruth E Farmer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- London School of Hygiene & Tropical Medicine, London, UK
| | - Olga Giannakopoulou
- Division of Psychiatry, University College London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Longitudinal Studies, University College London, London, UK
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
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Marcondes FO, Cheng D, Alegria M, Haas JS. Are racial/ethnic minorities recently diagnosed with diabetes less likely than white individuals to receive guideline-directed diabetes preventive care? BMC Health Serv Res 2021; 21:1150. [PMID: 34689778 PMCID: PMC8543926 DOI: 10.1186/s12913-021-07146-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Racial/ethnic disparities in diabetes care are pervasive, including the provision of care for prevention of complications. Prevention efforts should be focused on the time that immediately follows a diagnosis of diabetes. The aim of this study was to assess racial/ethnic differences in the receipt of guideline-directed diabetes care for complication prevention by individuals recently diagnosed with diabetes. METHODS We used repeated cross-sections of individuals recently diagnosed with diabetes (within the past 5 years) from the National Health Interview Survey from 2011 to 2017. Multivariate regression was used to estimate the associations between race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic) and guideline-directed process measures for prevention of diabetes complications (visits to an eye and foot specialist, and blood pressure and cholesterol checks by a health professional - each in the prior year). We assessed effect modification of these associations by socioeconomic status (SES). RESULTS In a sample of 7,341 participants, Hispanics had lower rates of having any insurance coverage (75.9 %) than Non-Hispanic Whites (93.2 %) and Blacks (88.1 %; p<0.001). After adjustment for demographics, total comorbidities, SES, and health insurance status, Hispanics were less likely to have an eye exam in the prior year (OR 0.80; (95 % CI 0.65-0.99); p=0.04) and a blood pressure check (OR 0.42; (95 % CI 0.28-0.65); p<0.001) compared to Non-Hispanic Whites. There was no significant effect modification of race/ethnicity by SES. CONCLUSIONS Hispanics recently diagnosed with diabetes were less likely to receive some indicators of guideline-directed care for the prevention of complications. Lack of insurance and SES may partially explain those differences. Future work should consider policy change and providers' behaviors linked to racial/ethnic disparities in diabetes care.
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Affiliation(s)
- Felippe O Marcondes
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, MA, Boston, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, MA, Boston, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA.
- Division of General Internal Medicine, MGH, 100 Cambridge St, Suite 1600, MA, 02114, Boston, USA.
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Nagar SD, Nápoles AM, Jordan IK, Mariño-Ramírez L. Socioeconomic deprivation and genetic ancestry interact to modify type 2 diabetes ethnic disparities in the United Kingdom. EClinicalMedicine 2021; 37:100960. [PMID: 34386746 PMCID: PMC8343245 DOI: 10.1016/j.eclinm.2021.100960] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a complex common disease that disproportionately impacts minority ethnic groups in the United Kingdom (UK). Socioeconomic deprivation (SED) is widely considered as a potential explanation for T2D ethnic disparities in the UK, whereas the effect of genetic ancestry (GA) on such disparities has yet to be studied. METHODS We leveraged data from the UK Biobank prospective cohort study, with participants enrolled between 2006 and 2010, to model the relationship between SED (Townsend index), GA (clustering principal components of whole genome genotype data), and T2D status (ICD-10 codes) across the three largest ethnic groups in the UK - Asian, Black, and White - using multivariable logistic regression. FINDINGS The Asian group shows the highest T2D prevalence (17·9%), followed by the Black (11·7%) and White (5·5%) ethnic groups. We find that both SED (OR: 1·11, 95% CI: 1·10-1·11) and non-European GA (OR South Asian versus European: 4·37, 95% CI: 4·10-4·66; OR African versus European: 2·52, 95% CI: 2·23-2·85) are significantly associated with the observed T2D disparities. GA and SED show significant interaction effects on T2D, with SED being a relatively greater risk factor for T2D for individuals with South Asian and African ancestry, compared to those with European ancestry. INTERPRETATION The significant interactions between SED and GA underscore how the effects of environmental risk factors can differ among ancestry groups, suggesting the need for group-specific interventions. FUNDING This work was supported by the National Institutes of Health (NIH) Distinguished Scholars Program (DSP) to LMR and the Division of Intramural Research (DIR) of the National Institute on Minority Health and Health Disparities (NIMHD) at NIH.
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Affiliation(s)
| | - Anna María Nápoles
- National Institute on Minority Health and Health Disparities, 3 Center Drive, Building 3, Floor 5, Bethesda, MD 20814, USA
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
- PanAmerican Bioinformatics Institute, Cali, Colombia
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, GA, USA
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, 3 Center Drive, Building 3, Floor 5, Bethesda, MD 20814, USA
- PanAmerican Bioinformatics Institute, Cali, Colombia
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Meza BC, Iacone D, Talwar D, Sankar WN, Shah AS. Socioeconomic Deprivation and Its Adverse Association with Adolescent Fracture Care Compliance. JB JS Open Access 2020; 5:e0064. [PMID: 33123665 PMCID: PMC7418910 DOI: 10.2106/jbjs.oa.19.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Socioeconomic deprivation increases fracture incidence in adolescents, but
its impact on fracture care is unknown. The area deprivation index (ADI),
which incorporates 17 factors from the U.S. Census, measures socioeconomic
deprivation in neighborhoods. This investigation aimed to determine the
impact of socioeconomic deprivation and other socioeconomic factors on
fracture care compliance in adolescents. Methods: This study included patients who were 11 to 18 years of age and received
fracture care at a single urban children’s hospital system between
2015 and 2017. Demographic information (sex, race, caregiver status,
insurance type) and clinical information (mechanism of injury, type of
treatment) were obtained. The ADI, which has a mean score of 100 points and
a standard deviation of 20 points, was used to quantify socioeconomic
deprivation for each patient’s neighborhood. The outcome variables
related to compliance included the quantity of no-show visits at the
orthopaedic clinic and delays in follow-up care of >1 week. Risk
factors for suboptimal compliance were evaluated by bivariate analysis and
multivariate logistic regression. Results: The cohort included 457 adolescents; 75.9% of the patients were male, and the
median age was 16.1 years. The median ADI was 101.5 points (interquartile
range, 86.3 to 114.9 points). Bivariate analyses demonstrated that higher
ADI, black race, single-parent caregiver status, Medicaid insurance,
non-sports mechanisms of injury, and surgical management are associated with
suboptimal fracture care compliance. Adolescents from the most socially
deprived regions were significantly more likely to have delays in care
(33.8% compared with 20.1%; p = 0.037) and miss scheduled orthopaedic
visits (29.9% compared with 7.1%; p < 0.001) compared with adolescents
from the least deprived regions. ADI, Medicaid insurance, and initial
presentation to the emergency department were independent predictors of
suboptimal care compliance, when controlling for other variables. Conclusions: Socioeconomic deprivation is associated with an increased risk of suboptimal
fracture care compliance in adolescents. Clinicians can utilize caregiver
and insurance status to better understand the likelihood of fracture care
compliance. These findings highlight the importance of understanding
differences in each family’s ability to adhere to the recommended
follow-up and of implementing measures to enhance compliance.
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Affiliation(s)
- Blake C Meza
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dina Iacone
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wudbhav N Sankar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Apurva S Shah
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sun X, Liabsuetrakul T, Xie X, Liu P. Catastrophic health expenditure and impoverishment for type 2 diabetes mellitus patients in a multiethnic province in China using a Blinder-Oaxaca decomposition: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17376. [PMID: 31574887 PMCID: PMC6775392 DOI: 10.1097/md.0000000000017376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This study aimed to compare the catastrophic health expenditure (CHE) and impoverishment of type 2 diabetes mellitus (T2DM) patients between 2 ethnic groups and explore the contribution of associated factors to ethnic differences in CHE and impoverishment in Ningxia Hui Autonomous Region, China.A cross-sectional study was conducted in 2 public hospitals from October 2016 to June 2017. Data were collected by interviewing eligible Hui and Han T2DM inpatients and reviewing the hospital electronic records. Both CHE and impoverishment were measured by headcount and gap. The contributions of associated factors to ethnic differences were analyzed by the Blinder-Oaxaca decomposition technique.Both the CHE and impoverishment of Hui patients before and after reimbursement were significantly higher than those of Han patients. The ethnic differences in CHE and impoverishment headcount after reimbursement were 11.9% and 9.8%, respectively. The different distributions of associated factors between Hui and Han patients contributed to 60.5% and 35.7% of ethnic differences in CHE and impoverishment, respectively. Household income, occupation, and region were significant contributing factors.Hui T2DM patients suffered greater CHE and impoverishment than Han patients regardless of reimbursements from health insurance. Differences in socioeconomic status between Hui and Han patients were the main factors behind the ethnic differences.
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Affiliation(s)
- Xian Sun
- Department of Epidemiology and Health Statistics, Faculty of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Xiaomin Xie
- Endocrinology Department, First People's Hospital of Yinchuan
| | - Ping Liu
- Endocrinology Department, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Strodel RJ, Chang CH, Khurana SG, Camp AW, Magenheimer EA, Hawley NL. Increased Awareness, Unchanged Behavior: Prediabetes Diagnosis in a Low-Income, Minority Population. DIABETES EDUCATOR 2019; 45:203-213. [PMID: 30704368 DOI: 10.1177/0145721719826578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the study was to explore preventive behaviors and attitudes among mostly low-income, young Hispanic women with and without prediabetes. Methods In 2017, a convenience sample of women without diabetes aged 18 to 49 years (n = 214, 77.8% Hispanic) was recruited from the waiting room of a community health center to complete a 77-item questionnaire. Attitudes, risk perception, and recent lifestyle change were measured using a validated instrument, the Risk Perceptions Survey: Developing Diabetes. Chi-squared tests and multivariable binary logistic regression were conducted to assess the relationship between prediabetes diagnosis and attitude or lifestyle variables. Results Women diagnosed with prediabetes were more likely to report worry about diabetes and to perceive themselves at higher risk for developing diabetes in the next 10 years than women without a prior prediabetes diagnosis. There was no significant association between prediabetes diagnosis and recent adoption of lifestyle changes compared with those without prediabetes. After controlling for demographic characteristics and risk factors for type 2 diabetes, prediabetes diagnosis was significantly associated with elevated risk perception for developing diabetes if no lifestyle change is made but not with worry or risk perception for developing diabetes generally. Conclusions Prediabetes diagnosis is associated with heightened perception of diabetes risk but not lifestyle change compared to women without prediabetes in this low-income, predominantly Hispanic population. Prediabetes counseling efforts must emphasize evidence-based approaches for motivating preventive behaviors.
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Affiliation(s)
| | | | | | - Anne W Camp
- Fair Haven Community Health Center, New Haven, Connecticut
| | | | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut
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Keil AP, Edwards JK. A review of time scale fundamentals in the g-formula and insidious selection bias. CURR EPIDEMIOL REP 2018; 5:205-213. [PMID: 30555772 PMCID: PMC6289285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW We review recent examples of data analysis with the g-formula, a powerful tool for analyzing longitudinal data and survival analysis. Specifically, we focus on the common choices of time scale and review inferential issues that may arise. RECENT FINDINGS Researchers are increasingly engaged with questions that require time scales subject to left-truncation and right-censoring. The assumptions necessary for allowing right-censoring are well defined in the literature, whereas similar assumptions for left-truncation are not well defined. Policy and biologic considerations sometimes dictate that observational data must be analyzed on time scales that are subject to left-truncation, such as age. SUMMARY Further consideration of left-truncation is needed, especially when biologic or policy considerations dictate that age is the relevant time scale of interest. Methodologic development is needed to reduce potential for bias when left-truncation may occur.
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Keil AP, Edwards JK. A Review of Time Scale Fundamentals in the g-Formula and Insidious Selection Bias. CURR EPIDEMIOL REP 2018. [DOI: 10.1007/s40471-018-0153-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pollock BD, Hu T, Chen W, Harville EW, Li S, Webber LS, Fonseca V, Bazzano LA. Utility of existing diabetes risk prediction tools for young black and white adults: Evidence from the Bogalusa Heart Study. J Diabetes Complications 2017; 31:86-93. [PMID: 27503406 PMCID: PMC5209262 DOI: 10.1016/j.jdiacomp.2016.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/29/2016] [Accepted: 07/24/2016] [Indexed: 01/02/2023]
Abstract
AIMS To evaluate several adult diabetes risk calculation tools for predicting the development of incident diabetes and pre-diabetes in a bi-racial, young adult population. METHODS Surveys beginning in young adulthood (baseline age ≥18) and continuing across multiple decades for 2122 participants of the Bogalusa Heart Study were used to test the associations of five well-known adult diabetes risk scores with incident diabetes and pre-diabetes using separate Cox models for each risk score. Racial differences were tested within each model. Predictive utility and discrimination were determined for each risk score using the Net Reclassification Index (NRI) and Harrell's c-statistic. RESULTS All risk scores were strongly associated (p<.0001) with incident diabetes and pre-diabetes. The Wilson model indicated greater risk of diabetes for blacks versus whites with equivalent risk scores (HR=1.59; 95% CI 1.11-2.28; p=.01). C-statistics for the diabetes risk models ranged from 0.79 to 0.83. Non-event NRIs indicated high specificity (non-event NRIs: 76%-88%), but poor sensitivity (event NRIs: -23% to -3%). CONCLUSIONS Five diabetes risk scores established in middle-aged, racially homogenous adult populations are generally applicable to younger adults with good specificity but poor sensitivity. The addition of race to these models did not result in greater predictive capabilities. A more sensitive risk score to predict diabetes in younger adults is needed.
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Affiliation(s)
- Benjamin D Pollock
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
| | - Tian Hu
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
| | - Wei Chen
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
| | - Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
| | - Shengxu Li
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
| | - Larry S Webber
- Department of Biostatistics & Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
| | - Vivian Fonseca
- Department of Endocrinology, Tulane University School of Medicine, New Orleans, LA 70112
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112
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Rodríguez JE, Campbell KM. Racial and Ethnic Disparities in Prevalence and Care of Patients With Type 2 Diabetes. Clin Diabetes 2017; 35:66-70. [PMID: 28144049 PMCID: PMC5241767 DOI: 10.2337/cd15-0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Genetic ancestry in relation to the metabolic response to a US versus traditional Mexican diet: a randomized crossover feeding trial among women of Mexican descent. Eur J Clin Nutr 2016; 71:395-401. [PMID: 27966572 PMCID: PMC5332296 DOI: 10.1038/ejcn.2016.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES Certain populations with a large proportion of indigenous American (IA) genetic ancestry may be evolutionarily adapted to traditional diets high in legumes and complex carbohydrates, and may have a detrimental metabolic response to US diets high in refined carbohydrates and added sugars. We tested whether IA ancestry modified the metabolic response to a US versus traditional Mexican diet in a controlled dietary intervention. SUBJECTS/METHODS First and second generation Mexican immigrant women (n=53) completed a randomized crossover feeding trial testing the effects of a US versus traditional Mexican diet. The metabolic response to the diets was measured by fasting serum concentrations of glucose, insulin, insulin-like growth factor-1 (IGF-1), IGF-binding protein-3 (IGFBP-3), adiponectin, C-reactive protein, interleukin-6 and computed homeostasis model assessment for insulin resistance (HOMAIR). Blood collected at baseline was used for genotyping, and estimation of African, European and IA ancestries with the use of 214 ancestry informative markers. RESULTS The genetic ancestral background was 56% IA, 38% European and 6% African. Women in the highest IA ancestry tertile (>62%) were shorter in height, less educated and less acculturated to the US lifestyle, and tended to have higher waist-to-hip ratio compared with women in the middle and lowest IA ancestry tertiles, respectively. Compared with the US diet, the traditional Mexican diet tended to reduce glucose, insulin, IGF-1, IGFBP-3 and HOMAIR among women in the middle IA ancestry group (IA ancestry ⩽45-62%), whereas having no effect on biomarkers related to inflammation. CONCLUSIONS We observed modest interactions between IA ancestry and the metabolic response to a US versus traditional Mexican diet among Mexican immigrant women.
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Friedman M. Mushroom Polysaccharides: Chemistry and Antiobesity, Antidiabetes, Anticancer, and Antibiotic Properties in Cells, Rodents, and Humans. Foods 2016; 5:E80. [PMID: 28231175 PMCID: PMC5302426 DOI: 10.3390/foods5040080] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/10/2016] [Accepted: 11/22/2016] [Indexed: 02/07/2023] Open
Abstract
More than 2000 species of edible and/or medicinal mushrooms have been identified to date, many of which are widely consumed, stimulating much research on their health-promoting properties. These properties are associated with bioactive compounds produced by the mushrooms, including polysaccharides. Although β-glucans (homopolysaccharides) are believed to be the major bioactive polysaccharides of mushrooms, other types of mushroom polysaccharides (heteropolysaccharides) also possess biological properties. Here we survey the chemistry of such health-promoting polysaccharides and their reported antiobesity and antidiabetic properties as well as selected anticarcinogenic, antimicrobial, and antiviral effects that demonstrate their multiple health-promoting potential. The associated antioxidative, anti-inflammatory, and immunomodulating activities in fat cells, rodents, and humans are also discussed. The mechanisms of action involve the gut microbiota, meaning the polysaccharides act as prebiotics in the digestive system. Also covered here are the nutritional, functional food, clinical, and epidemiological studies designed to assess the health-promoting properties of polysaccharides, individually and as blended mixtures, against obesity, diabetes, cancer, and infectious diseases, and suggestions for further research. The collated information and suggested research needs might guide further studies needed for a better understanding of the health-promoting properties of mushroom polysaccharides and enhance their use to help prevent and treat human chronic diseases.
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Affiliation(s)
- Mendel Friedman
- Western Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, 800 Buchanan Street, Albany, CA 94710, USA.
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18
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Piccolo RS, Subramanian SV, Pearce N, Florez JC, McKinlay JB. Relative Contributions of Socioeconomic, Local Environmental, Psychosocial, Lifestyle/Behavioral, Biophysiological, and Ancestral Factors to Racial/Ethnic Disparities in Type 2 Diabetes. Diabetes Care 2016; 39:1208-17. [PMID: 27330127 PMCID: PMC4915558 DOI: 10.2337/dc15-2255] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Racial/ethnic minorities in the U.S. have a higher prevalence of type 2 diabetes mellitus (T2DM) than white adults. While many independent risk factors for T2DM have been identified, these determinants are often viewed in isolation without considering the joint contributions of competing risk factors. The objective of this study was to assess the relative contributions of six domains of influence to racial/ethnic disparities in T2DM. RESEARCH DESIGN AND METHODS Cross-sectional analyses were conducted using the Boston Area Community Health III Survey (2010-2012), the third wave of a population-based sample of men and women from three racial/ethnic groups (black, Hispanic, white) living in Boston, Massachusetts (N = 2,764). Prevalent diabetes was defined by self-report of T2DM, fasting glucose >125 mg/dL, or HbA1c ≥6.5%. Structural equation models were constructed to evaluate the direct effects of each conceptual domain of influence on T2DM prevalence, as well as their indirect effects on the race/ethnicity-T2DM relationship. All direct and indirect pathways were included. RESULTS The final model indicated that 38.9% and 21.8% of the total effect of black race and Hispanic ethnicity, respectively, on T2DM prevalence was mediated by the socioeconomic, environmental, psychosocial, and lifestyle/behavioral risk scores. The largest mediating influence was the socioeconomic risk score, which explained 21.8% and 26.2% of the total effect of black race and Hispanic ethnicity, respectively. CONCLUSIONS Our study found that socioeconomic factors had the greatest impact on explaining the excess prevalence of T2DM among racial/ethnic minorities.
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Affiliation(s)
| | - S V Subramanian
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, U.K
| | - Jose C Florez
- Diabetes Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - John B McKinlay
- Department of Epidemiology, New England Research Institutes, Watertown, MA
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Racial-ethnic disparities in the association between risk factors and diabetes: The Northern Manhattan Study. Prev Med 2016; 83:31-6. [PMID: 26658025 PMCID: PMC4724287 DOI: 10.1016/j.ypmed.2015.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/02/2015] [Accepted: 11/27/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify risk factors (RF) for diabetes within a multiethnic cohort and to examine whether race-ethnicity modified their effects. METHODS Participants in the Northern Manhattan Study without diabetes at baseline were studied from 1993 to 2014 (n=2430). Weibull regression models with interval censoring data were fit to calculate hazard ratios and 95% confidence intervals for incident diabetes. We tested for interactions between RF and race-ethnicity. RESULTS During a mean follow-up period of 11years, there were 449 diagnoses of diabetes. Being non-Hispanic black (HR 1.69 95% CI 1.11-2.59) or Hispanic (HR 2.25 95% CI 1.48-3.40) versus non-Hispanic white, and body mass index (BMI; HR 1.34 per SD 95% CI 1.21-1.49) were associated with greater risk of diabetes; high-density lipoprotein cholesterol (HR 0.75 95% CI 0.66-0.86) was protective. There were interactions by race-ethnicity. In stratified models, the effects of BMI, current smoking, and C-reactive protein (CRP) on risk of diabetes differed by race-ethnicity (p for interaction <0.05). The effects were greater among non-Hispanic whites than non-Hispanic blacks and Hispanics. CONCLUSIONS Although Hispanics and non-Hispanic blacks had a greater risk of diabetes than whites, there were variations by race-ethnicity in the association of BMI, smoking, and CRP with risk of diabetes. Unique approaches should be considered to reduce diabetes as traditional RF may not be as influential in minority populations.
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Chow W, Buysman E, Rupnow MFT, Aguilar R, Henk HJ. Canagliflozin treatment of Hispanic and non-Hispanic patients with type 2 diabetes in a US managed care setting. Curr Med Res Opin 2016; 32:13-22. [PMID: 26414434 DOI: 10.1185/03007995.2015.1100598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hispanic/Latino (H/L) ethnicity is associated with higher prevalence of type 2 diabetes mellitus (T2DM) and more complications and comorbidities. Few studies of antihyperglycemic agents (AHAs) have compared H/L with non-H/L patients. Randomized controlled trials and observational studies have shown canagliflozin (CANA) is effective at lowering hemoglobin A1C (A1C). OBJECTIVE To describe characteristics and compare glycemic control between H/L and non-H/L patients with T2DM filling their first prescription for CANA. METHODS This retrospective cohort study examined healthcare claims for diabetic patients who filled ≥1 prescription for CANA between 1 April 2013 and 31 October 2013. We captured available demographic data; ethnicity was imputed as previously published. Clinical data included the Diabetes Complications Severity Index (DCSI), A1C values, and claims for any AHA, with 6 months of follow-up. RESULTS Our sample included 438 (11.4%) H/L individuals and 3408 (88.6%) non-H/L individuals; each cohort had 43% females. The H/L patients were younger (53 vs. 56 years, p < 0.001) with higher mean baseline A1C (8.9% vs. 8.5%, respectively; p = 0.028) compared to non-H/L patients. Mean DCSI was similar (H/L 0.92 vs. non-H/L 0.84, p = 0.289) between cohorts. More H/L patients (25%) were taking ≥3 AHAs at the first CANA prescription fill (vs. 21% for non-H/L; p = 0.044), most commonly metformin, followed by sulfonylureas, dipeptidyl peptidase-4 inhibitors, and basal insulin. Among patients with ≥2 fills for CANA, mean adherence (proportion of days covered) was slightly lower for H/L than non-H/L patients (0.77 vs. 0.80, p = 0.003). From their respective baseline A1C values, reduction in A1C was significantly greater for H/L than non-H/L patients (1.1% vs. 0.8%; p = 0.043). CONCLUSION Compared with non-H/L patients, our H/L patients were younger and had higher mean baseline A1C. Significant improvement in glycemic control was observed for both cohorts, with greater improvement for H/L patients. Additional research is warranted, including longer follow-up and adjusting for possible confounding factors.
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Affiliation(s)
- Wing Chow
- a a Health Economics & Outcomes Research, Janssen Scientific Affairs LLC , Raritan , NJ , USA
| | - Erin Buysman
- b b Health Economics and Outcomes Research , Optum, Eden Prairie, MN , USA
| | - Marcia F T Rupnow
- a a Health Economics & Outcomes Research, Janssen Scientific Affairs LLC , Raritan , NJ , USA
| | | | - Henry J Henk
- b b Health Economics and Outcomes Research , Optum, Eden Prairie, MN , USA
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Shomaker LB, Goodman E. An 8-Year Prospective Study of Depressive Symptoms and Change in Insulin From Adolescence to Young Adulthood. Psychosom Med 2015; 77:938-45. [PMID: 26368574 PMCID: PMC4658292 DOI: 10.1097/psy.0000000000000230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate whether depressive symptoms predict change in fasting insulin among adolescents followed into young adulthood. We hypothesized that higher depressive symptoms would predict increased insulin and that puberty and race/ethnicity would moderate this relationship. METHODS Data came from the Princeton School District Study, a school-based longitudinal cohort of non-Hispanic black and white adolescents (2001-2011). Depressive symptoms, fasting insulin, and body mass index were measured at baseline (adolescence) and 8 years later (young adulthood) in 685 participants. Puberty was assessed using a validated protocol measuring sex steroids and physical changes. The primary outcome was change in fasting insulin. Analyses accounted for age, sex, race, parental education, baseline insulin, body mass index z score, puberty, and time to follow-up. RESULTS At baseline, depressive symptoms were correlated with insulin (ρ = 0.13, p = .001). High baseline insulin predicted insulin change (B = -11.50, standard error [SE] = 2.30, p < .001). Depressive symptoms also predicted insulin change, but only for pubertal adolescents (B = -0.23, SE = 0.11, p = .038). This relationship was moderated by race (p = .047); depressive symptoms predicted insulin change only among pubertal black adolescents (p = .030), not white (p = .49), and in the direction opposite that hypothesized (Bblacks = -0.51, SE = 0.23). Post hoc analyses revealed that pubertal black adolescents with high depressive symptoms had the highest baseline insulin, which stayed high across the follow-up period. CONCLUSIONS Among pubertal black adolescents, elevated depressive symptoms are associated with increased risk for sustained hyperinsulinemia from adolescence into adulthood. These youths may be particularly vulnerable for Type 2 diabetes.
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Affiliation(s)
- Lauren B. Shomaker
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Elizabeth Goodman
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Abstract
BACKGROUND As of 2012, nearly 10% of Americans had diabetes mellitus. People with diabetes are at approximately double the risk of premature death compared with those in the same age groups without the condition. While the prevalence of diabetes has risen across all racial/ethnic groups over the past 30 years, rates are higher in minority populations. The objective of this review article is to evaluate the prevalence of diabetes and disease-related comorbidities as well as the primary endpoints of clinical studies assessing glucose-lowering treatments in African Americans, Hispanics, and Asians. METHODS As part of our examination of this topic, we reviewed epidemiologic and outcome publications. Additionally, we performed a comprehensive literature search of clinical trials that evaluated glucose-lowering drugs in racial minority populations. For race/ethnicity, we used the terms African American, African, Hispanic, and Asian. We searched PubMed for clinical trial results from 1996 to 2015 using these terms by drug class and specific drug. Search results were filtered qualitatively. RESULTS Overall, the majority of publications that fit our search criteria pertained to native Asian patient populations (i.e., Asian patients in Asian countries). Sulfonylureas; the α-glucosidase inhibitor, miglitol; the biguanide, metformin; and the thiazolidinedione, rosiglitazone have been evaluated in African American and Hispanic populations, as well as in Asians. The literature on other glucose-lowering drugs in non-white races/ethnicities is more limited. CONCLUSIONS Clinical data are needed for guiding diabetes treatment among racial minority populations. A multi-faceted approach, including vigilant screening in at-risk populations, aggressive treatment, and culturally sensitive patient education, could help reduce the burden of diabetes on minority populations. To ensure optimal outcomes, educational programs that integrate culturally relevant approaches should highlight the importance of risk-factor control in minority patients.
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Goonesekera SD, Fang SC, Piccolo RS, Florez JC, McKinlay JB. Biogeographic ancestry is associated with higher total body adiposity among African-American females: the Boston Area Community Health Survey. PLoS One 2015; 10:e0122808. [PMID: 25875902 PMCID: PMC4395279 DOI: 10.1371/journal.pone.0122808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/13/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The prevalence of obesity is disproportionately higher among African-Americans and Hispanics as compared to whites. We investigated the role of biogeographic ancestry (BGA) on adiposity and changes in adiposity in the Boston Area Community Health Survey. METHODS We evaluated associations between BGA, assessed via Ancestry Informative Markers, and adiposity (body mass index (BMI), percent body fat (PBF), and waist-to-hip ratio (WHR)) and changes in adiposity over 7 years for BMI and WHR and 2.5 years for PBF, per 10% greater proportion of BGA using multivariable linear regression. We also examined effect-modification by demographic and socio-behavioral variables. RESULTS We observed positive associations between West-African ancestry and cross-sectional BMI (percent difference=0.62%; 95% CI: 0.04%, 1.20%), and PBF (β=0.35; 95% CI: 0.11, 0.58). We also observed significant effect-modification of the association between West-African ancestry and BMI by gender (p-interaction: <0.002) with a substantially greater association in women. We observed no main associations between Native-American ancestry and adiposity but observed significant effect-modification of the association with BMI by diet (p-interaction: <0.003) with inverse associations among participants with higher Healthy Eating Scores. No associations were observed between BGA and changes in adiposity over time. CONCLUSION Findings support that West-African ancestry may contribute to high prevalence of total body adiposity among African-Americans, particularly African-American women.
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Affiliation(s)
- Sunali D. Goonesekera
- Department of Epidemiology and Biostatistics, New England Research Institutes, 480 Pleasant St., Watertown, MA 02472, United States of America
- * E-mail:
| | - Shona C. Fang
- Department of Epidemiology and Biostatistics, New England Research Institutes, 480 Pleasant St., Watertown, MA 02472, United States of America
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, United States of America
| | - Rebecca S. Piccolo
- Department of Epidemiology and Biostatistics, New England Research Institutes, 480 Pleasant St., Watertown, MA 02472, United States of America
| | - Jose C. Florez
- Diabetes Unit/ Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - John B. McKinlay
- Department of Epidemiology and Biostatistics, New England Research Institutes, 480 Pleasant St., Watertown, MA 02472, United States of America
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