Prevalence of Diabetes and Cardiovascular Risk Factors Among California Native American Adults Compared to Other Ethnicities: The 2005 California Health Interview Survey

Epidemiology and risk factors for diabetes in the suburbs of Beijing: a retrospective cohort study

OBJECTIVE

We aimed to detect the incidence and risk factors of type 2 diabetes mellitus (T2DM) development in the suburbs of Beijing.

DESIGN

Cohort study with record linkage to incidence data.

SETTING

We performed a 5-year follow-up study in a randomly selected suburban population including 1114 subjects aged ≥18 years living in the suburbs of Beijing.

PARTICIPANTS

118 subjects with T2DM at baseline according to the 1999 WHO criteria were excluded, and 895 subjects attended the follow-up assessment in 2012. The non-diabetic subjects at baseline were classified into two groups: normal glucose tolerance (NGT) group (n=673) and impaired glucose regulation (IGR) group(n=222).The incidence and risk factors of diabetes development in each group were investigated.

OUTCOME MEASURES

A structured questionnaire about sociodemographic characteristics, height, weight, waist circumference, hip circumference, blood pressure, oral glucose tolerance test and serum lipid levels.

RESULTS

Out of the 895 non-diabetic subjects, 67 developed diabetes with 29 in the NGT group and 38 in the IGR group, respectively, after a 5-year follow-up, producing an overall 5-year cumulative incidence of diabetes of 13%. The incidence of diabetes was 15.5 cases per 1000 person-years, 8.9 cases per 1000 person-years in the NGT group and 35.7 cases per 1000 person-years in the IGR group (p<0.01; RR 4.03; 95% CI 2.58 to 9.29). Binary logistic regression analysis showed that the risk factors for diabetes development included fasting plasma glucose (FPG) in the NGT group, and sex, the waist-to-hip ratio, FPG and diastolic blood pressure (DBP) in the IGR group.

CONCLUSIONS

During a mean follow-up of 5.0 years, the incidence of T2DM in the suburbs of Beijing was 15.5 per 1000 person-years. Early prevention of diabetes should focus on IGR subjects. Elevated FPG predicted diabetes development for both NGT and IGR subjects. Female sex, overweight/obesity and DBP are risk factors for diabetes development in IGR subjects.

Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review

BACKGROUND

Indigenous peoples worldwide carry a disproportionate tuberculosis burden. There is an increasing awareness of the effect of social determinants and proximate determinants such as alcohol use, overcrowding, type 1 and type 2 diabetes, substance misuse, HIV, food insecurity and malnutrition, and smoking on the burden of tuberculosis. We aimed to understand the potential contribution of such determinants to tuberculosis in Indigenous peoples and to document steps taken to address them.

METHODS

We did a systematic review using seven databases (MEDLINE, Embase, CINAHL, Global Health, BIOSIS Previews, Web of Science, and the Cochrane Library). We identified English language articles published from Jan 1, 1980, to Dec 20, 2017, reporting the prevalence of proximate determinants of tuberculosis and preventive programmes targeting these determinants in Indigenous communities worldwide. We included any randomised controlled trials, controlled studies, cohort studies, cross-sectional studies, case reports, and qualitative research. Exclusion criteria were articles in languages other than English, full text not available, population was not Indigenous, focused exclusively on children or older people, and studies that focused on pharmacological interventions.

FINDINGS

Of 34 255 articles identified, 475 were eligible for inclusion. Most studies confirmed a higher prevalence of proximate determinants in Indigenous communities than in the general population. Diabetes was more frequent in Indigenous communities within high-income countries versus in low-income countries. The prevalence of alcohol use was generally similar to that among non-Indigenous groups, although patterns of drinking often differed. Smoking prevalence and smokeless tobacco consumption were commonly higher in Indigenous groups than in non-Indigenous groups. Food insecurity was highly prevalent in most Indigenous communities evaluated. Substance use was more frequent in Indigenous inhabitants of high-income countries than of low-income countries, with wide variation across Indigenous communities. The literature pertaining to HIV, crowding, and housing conditions among Indigenous peoples was too scant to draw firm conclusions. Preventive programmes that are culturally appropriate targeting these determinants appear feasible, although their effectiveness is largely unproven.

INTERPRETATION

Indigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis.

FUNDING

Canadian Institutes of Health Research.

Prevalence and Risk for Negative Disability Outcomes Between American Indians-Alaskan Natives and Other Race-Ethnic Groups in the Southwestern United States

In the USA, some race-ethnic minorities are unjustly relegated to the margins of society. As a consequence, these groups are more frequently found to have risk profiles associated with adverse health than individuals from the majority group (non-Hispanic Whites). Limited research has been devoted to investigating how American Indians and Alaska Natives (AIANs) differ from other race-ethnic minorities and the majority group with regard to prevalence and risk for self-care, independent living, and ambulatory disabilities. Our investigation attempts to quantify both of these tracks by accounting for race-ethnic and poverty status. Our cross-sectional analysis used nationally representative data from the American Community Survey (ACS) 5-year (2009-2013) Public Use Microdata Sample (PUMS) file to address this literature gap. We selected survey participants from the four states with the largest concentration of AIANs in the USA (Arizona, California, New Mexico, and Oklahoma). We used information on 2,428,233 individuals to generalize prevalence of and risk for disability to 49,994,332 individuals in the Southwest US. We found disability (self-reported) prevalence differed between our six race-ethnic groups in statistically significant and complex ways. Population-weighted logistic regression analyses adjusting for age, sex, and citizenship found AIANs have a higher risk for disability than non-Hispanic Whites, non-Hispanic Asians, and Hispanics. In order to impact public health and build a more equitable society, efforts should continue to identify health disparities. Researchers should continue to advance conceptual frameworks on plausible causal mechanisms between markers of social stratification and disablement processes.

Unconscious biases: racial microaggressions in American Indian health care

PURPOSE

This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM).

METHODS

This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM.

RESULTS

Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models.

CONCLUSIONS

Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

The Prevalence and Correlates of Mental and Emotional Health Among American Indian Adults With Type 2 Diabetes

AIMS

The purpose of this study was to examine the prevalence and correlates of mental and emotional health factors among a sample of American Indian (Indigenous) adults diagnosed with type 2 diabetes.

METHODS

Data are from a community-based participatory research project involving 2 Indigenous reservation communities. Data were collected from 218 Indigenous adults diagnosed with type 2 diabetes via in-person paper-and-pencil survey interviews.

RESULTS

Reports of greater numbers of mental/emotional health problems were associated with increases in self-reported hyperglycemia, comorbid health problems, and health-impaired physical activities.

CONCLUSIONS

This study addresses a gap in the literature by demonstrating the associations between various mental/emotional health factors and diabetes-related health problems for Indigenous Americans. Findings underscore the importance of holistic, integrated primary care models for more effective diabetes care.

Disparities in healthcare utilisation rates for Aboriginal and non-Aboriginal Albertan residents, 1997-2006: a population database study

BACKGROUND

It is widely recognised that significant discrepancies exist between the health of indigenous and non-indigenous populations. Whilst the reasons are incompletely defined, one potential cause is that indigenous communities do not access healthcare to the same extent. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities.

METHODS

Healthcare utilisation data over a nine-year period were analysed for a cohort of nearly two million individuals to determine the rates at which Aboriginal and non-Aboriginal populations utilised two specialties (Cardiology and Ophthalmology) in Alberta, Canada. Unadjusted and adjusted healthcare utilisation rates obtained by mixed linear and Poisson regressions, respectively, were compared amongst three population groups - federally registered Aboriginals, individuals receiving welfare, and other Albertans.

RESULTS

Healthcare utilisation rates for Aboriginals were substantially lower than those of non-Aboriginals and welfare recipients at each time point and subspecialty studied [e.g. During 2005/06, unadjusted Cardiology utilisation rates were 0.28% (Aboriginal, n = 97,080), 0.93% (non-Aboriginal, n = 1,720,041) and 1.37% (Welfare, n = 52,514), p = <0.001]. The age distribution of the Aboriginal population was markedly different [2.7%≥65 years of age, non-Aboriginal 10.7%], and comparable utilisation rates were obtained after adjustment for fiscal year and estimated life expectancy [Cardiology: Incidence Rate Ratio 0.66, Ophthalmology: IRR 0.85].

DISCUSSION

The analysis revealed that Aboriginal people utilised subspecialty healthcare at a consistently lower rate than either comparatively economically disadvantaged groups or the general population. Notably, the differences were relatively invariant between the major provincial centres and over a nine year period. Addressing the causes of these discrepancies is essential for reducing marked health disparities, and so improving the health of Aboriginal people.

Exercise training in high-risk ethnic populations with type 2 diabetes: a systematic review of clinical trials

BACKGROUND

To review clinical trials that have prescribed exercise training in high-risk, ethnic populations with type 2 diabetes mellitus (T2DM) and delineate areas for future research.

METHOD

A systematic review using computerized databases was performed.

RESULTS

The systematic review located nine trials, including four uncontrolled trials, and five randomized controlled trials (RCTs) that included 521 participants. Cohorts studied included African, Indian, Polynesian, Hispanic, Arabian, and Chinese peoples and interventions included aerobic training, resistance training or a combination thereof. Several trials documented improvements in HbA1c, insulin action, body composition, blood lipids and systolic and diastolic blood pressure. In general, a longer duration and greater frequency of training resulted in greater adaptation. Studies demonstrating no effect were generally limited by an inadequate intervention. There was evidence of differential training responses between Caucasians and non-Caucasians in two studies drawing such comparisons.

CONCLUSIONS

Robust RCTs prescribing appropriate, targeted interventions and investigating relevant outcomes may be required to stimulate greater advocacy for exercise as a therapeutic adjunct for diabetes management in these populations. Investigations should be extended to other high-risk populations, particularly indigenous peoples who suffer an extreme burden of T2DM. Translation of research into clinical application should remain the overall objective.

Weight status of American Indian and white elementary school students living in the same rural environment, Oklahoma, 2005-2009

Introduction

Studies have assessed rates of childhood obesity in diverse populations, but few have been able to compare the weight status of American Indian and white children living in the same community and attending the same schools. The objective of this study was to measure and compare the weight status of American Indian and white elementary school students (kindergarten through 5th grade) from 2005 through 2009 in an Oklahoma school district.

Methods

We assessed height, weight, age, and sex to calculate body mass index, body mass percentile, and categorical weight status of students, based on the Centers for Disease Control and Prevention 2000 Growth Charts. We used binomial regression to generate risk ratios (RRs) to compare student weight status by race, sex, and age.

Results

An average of 753 students was measured in each year; mean age was 8.3 years. From 2005 through 2009, 45.4% of American Indian students and 65.1% of white students were healthy weight or underweight. Greater proportions of American Indian children were very obese (weighted average RR, 2.0); obese (weighted average RR, 1.6), or overweight (weighted average RR, 1.8) compared with white children. The overall prevalence of excess weight changed little during the study period.

Conclusion

American Indian children had a greater risk of being overweight, obese, or very obese than white children from the same rural environment.

Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective

The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.