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Hayanga B, Stafford M, Bécares L. Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis. BMC Public Health 2023; 23:178. [PMID: 36703163 PMCID: PMC9879746 DOI: 10.1186/s12889-022-14940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
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Tyrer F, Ling S, Bhaumik S, Gangadharan SK, Khunti K, Gray LJ, Dunkley AJ. Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:287-295. [PMID: 31976599 DOI: 10.1111/jir.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors. METHOD This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population. RESULTS The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated. CONCLUSIONS A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.
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Affiliation(s)
- F Tyrer
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S Ling
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - S Bhaumik
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - S K Gangadharan
- Learning Disability Services, Leicestershire Partnership NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
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3
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Mathur R, Palla L, Farmer RE, Chaturvedi N, Smeeth L. Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink. Diabetes Res Clin Pract 2020; 160:108006. [PMID: 31923438 PMCID: PMC7042884 DOI: 10.1016/j.diabres.2020.108006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022]
Abstract
AIMS To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. METHODS An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. RESULTS In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. CONCLUSIONS We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.
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Affiliation(s)
- R Mathur
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - L Palla
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - R E Farmer
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences, Gower Street, London WC1E 6BT, UK.
| | - L Smeeth
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
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Anioke IC, Ezedigboh AN, Dozie-Nwakile OC, Chukwu IJ, Kalu PN. Predictors of poor glycemic control in adult with type 2 diabetes in South-Eastern Nigeria. Afr Health Sci 2019; 19:2819-2828. [PMID: 32127857 PMCID: PMC7040317 DOI: 10.4314/ahs.v19i4.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The study investigated predictors of poor glycemic control in type 2 diabetes (T2DM). METHODS Data on demographics, anthropometric and clinical parameters were collected in a cross-section survey from 140 adults with T2DM, using standard tools/instruments. Glycated hemoglobin (A1C) was assessed as a measure of glycemic control. RESULTS Majority (83.3%) had poor glycemic control status of which about 95% constitute the elderly. The elderly (OR= 5.90, 95% Cl: 1.66-20.96) were more likely associated with poor glycemic control than the non-elderly (p = 0.006). Adjustment for significant predictor variables: Age, waist-hip ratio (WHR), Fasting plasma glucose (FPG) and Systolic blood pressure (SBP), although attenuated the odds (OR= 5.00, 95% CI: 1.19-20.96) of poor glycemic control, it still remained significantly (p = 0.028) higher in the elderly. Patients outside tight FPG control significantly (p = 0.001) showed poor glycemic cotrol than those within tight FPG (OR= 17.39, 95%Cl: 5.83-51.90), even with attenuated OR (OR= 10.85, 95%Cl: 3.10-37.96) and (OR=12.08, 95%Cl: 3.64-40.09) when non-significant and significant predictor variables were accounted for, respectively. CONCLUSION Age, WHR, FPG, and SBP were significantly associated with differences in glycemic control. The elderly and FPG outside tight control showed significantly increased odds of poor glycemic control status.
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Affiliation(s)
- Innocent Chidi Anioke
- Clinical Chemistry Unit; Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Enugu Campus, Nigeria
- Public Health- Health Promotion, School of Health and Wellbeing, Faculty of Health and Social Science, Leeds Beckett University, Leeds, United Kingdom
| | - Azubike Nnamdi Ezedigboh
- Chemical pathology Unit; Department of Medical Laboratory Services, University of Nigeria Teaching Hospital Ituku/Ozolla Enugu, Nigeria
| | - Ogechukwu Calista Dozie-Nwakile
- Medical Laboratory Microbiology Unit; Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Ikechukwu Johnpaul Chukwu
- Clinical Chemistry Unit; Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Enugu Campus, Nigeria
- Biomolecular and Biomedical Sciences, Glasgow Caledonian University, United Kingdom
| | - Peculiar Ngozi Kalu
- Department of Chemical Pathology, College of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria
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5
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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Patel N, Ferrer HB, Tyrer F, Wray P, Farooqi A, Davies MJ, Khunti K. Barriers and Facilitators to Healthy Lifestyle Changes in Minority Ethnic Populations in the UK: a Narrative Review. J Racial Ethn Health Disparities 2016; 4:1107-1119. [PMID: 27928772 PMCID: PMC5705764 DOI: 10.1007/s40615-016-0316-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/08/2016] [Accepted: 11/14/2016] [Indexed: 01/27/2023]
Abstract
Minority ethnic populations experience a disproportionate burden of health inequalities compared with the rest of the population, including an increased risk of type 2 diabetes (T2DM). The purpose of this narrative review was to explore knowledge and attitudes around diabetes, physical activity and diet and identify barriers and facilitators to healthy lifestyle changes in minority ethnic populations in the UK. The narrative review focused on three key research topics in relation to barriers and facilitators to healthy lifestyle changes in minority adult ethnic populations: (i) knowledge and attitudes about diabetes risk; (ii) current behaviours and knowledge about physical activity and diet; and (iii) barriers and facilitators to living a healthier lifestyle. Nearly all of the studies that we identified reported on South Asian minority ethnic populations; we found very few studies on other minority ethnic populations. Among South Asian communities, there was generally a good understanding of diabetes and its associated risk factors. However, knowledge about the levels of physical activity required to gain health benefits was relatively poor and eating patterns varied. Barriers to healthy lifestyle changes identified included language barriers, prioritising work over physical activity to provide for the family, cultural barriers with regard to serving and eating traditional food, different perceptions of a healthy body weight and fear of racial harassment or abuse when exercising. Additional barriers for South Asian women included expectations to remain in the home, fear for personal safety, lack of same gender venues and concerns over the acceptability of wearing ‘western’ exercise clothing. Facilitators included concern that weight gain might compromise family/carer responsibilities, desire to be healthy, T2DM diagnosis and exercise classes held in ‘safe’ environments such as places of worship. Our findings suggest that South Asian communities are less likely to engage in physical activity than White populations and highlight the need for health promotion strategies to engage people in these communities. There is a gap in knowledge with regard to diabetes, physical activity, diet and barriers to healthy lifestyle changes among other ethnic minority populations in the UK; we recommend further research in this area.
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Affiliation(s)
- Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Paula Wray
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Azhar Farooqi
- Leicester City Clinical Commissioning Group, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Schnier C, Wild S, Kurdi Z, Povey C, Goldberg DJ, Hutchinson SJ. Matched population-based study examining the risk of type 2 diabetes in people with and without diagnosed hepatitis C virus infection. J Viral Hepat 2016; 23:596-605. [PMID: 26910297 DOI: 10.1111/jvh.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/14/2016] [Indexed: 01/03/2023]
Abstract
Meta-analyses have found hepatitis C virus (HCV) infection to be associated with an increased risk of type 2 diabetes mellitus (T2DM). Here, we examine this association within a large population-based study, according to HCV RNA status. A data-linkage approach was used to examine the excess risk of diagnosed T2DM in people diagnosed with antibodies to HCV (anti-HCV) in Scotland (21 929 anti-HCV(+ves) ; involving 15 827 HCV RNA(+ves) , 3927 HCV RNA(-ves) and 2175 with unknown RNA-status) compared to that of a threefold larger general population sample matched for gender, age and postcode (65 074 anti-HCV(-ves) ). To investigate effects of ascertainment bias the following periods were studied: up to 1 year before (pre-HCV)/within 1 year of (peri-HCV)/more than 1 year post (post-HCV) the date of HCV-diagnosis. T2DM had been diagnosed in 2.9% of anti-HCV(+ves) (including 3.2% of HCV RNA(+ves) and 2.3% of HCV RNA(-ves) ) and 2.7% of anti-HCV(-ves) . A higher proportion of T2DM was diagnosed in the peri-HCV period (i.e. around the time of HCV-diagnosis) for the anti-HCV(+ves) (22%) compared to anti-HCV(-ves) (10%). In both the pre-HCV and post-HCV periods, only those anti-HCV(+ves) living in less deprived areas (13% of the cohort) were found to have a significant excess risk of T2DM compared to anti-HCV(-ves) (adjusted odds ratio in the pre-HCV period: 4.0 for females and 2.3 for males; adjusted hazard ratio in the post-HCV period: 1.5). These findings were similarly observed for both HCV RNA(+ves) (chronic) and HCV RNA(-ves) (resolved). In the largest study of T2DM among chronic HCV-infected individuals to date, there was no evidence to indicate that infection conveyed an appreciable excess risk of T2DM at the population level.
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Affiliation(s)
- C Schnier
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - S Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Z Kurdi
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - C Povey
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
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Creamer J, Attridge M, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane Review of randomized controlled trials. Diabet Med 2016. [PMID: 26202820 DOI: 10.1111/dme.12865] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To give an updated perspective of interventions from additional data collected since our first review, conducted in 2008. BACKGROUND This updated Cochrane Review incorporates new information from recent randomized controlled trials on culturally appropriate diabetes health education interventions. METHODS An electronic literature search of six databases was repeated, with databases of ongoing trials checked and three journals hand-searched. Meta-analysis was carried out for sufficiently homogeneous outcomes, and common themes among trials were highlighted. RESULTS A total of 22 new trials were added to the original 11. Meta-analysis of 28 trials containing suitable data showed significant improvements in glycaemic control (HbA1c ) and diabetes knowledge over a period of 24 months, after the delivery of culturally appropriate education to participants, compared with those receiving 'conventional' care. There were no consistent benefits over the control group in other selected outcome measures, and lack of data continued to make analysis of several outcome measures difficult. CONCLUSIONS Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.
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Affiliation(s)
- J Creamer
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - M Attridge
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - M Ramsden
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - R Cannings-John
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - K Hawthorne
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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van Gemert C, Wang J, Simmons J, Cowie B, Boyle D, Stoove M, Enright C, Hellard M. Improving the identification of priority populations to increase hepatitis B testing rates, 2012. BMC Public Health 2016; 16:95. [PMID: 26832144 PMCID: PMC4735953 DOI: 10.1186/s12889-016-2716-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background It is estimated that over 40 % of the 218,000 people with chronic hepatitis B (CHB) in Australia in 2011 are undiagnosed. A disproportionate number of those with undiagnosed infection were born in the Asia-Pacific region. Undiagnosed CHB can lead to ongoing transmission and late diagnosis limits opportunities to prevent progression to hepatocellular carcinoma (HCC) and cirrhosis. Strategies are needed to increase testing for hepatitis B virus (HBV) (including culturally and linguistically diverse communities, Aboriginal and/or Torres Strait Islander (Indigenous) people and people who inject drugs). General practitioners (GPs) have a vital role in increasing HBV testing and the timely diagnosis CHB. This paper describes the impact of a GP-based screening intervention to improve CHB diagnosis among priority populations in Melbourne, Australia. Methods A non-randomised, pre-post intervention study was conducted between 2012 and 2013 with three general practices in Melbourne, Australia. Using clinic electronic health records three priority populations known to be at increased CHB risk in Australia (1: Asian-born patients or patients of Asian ethnicity living in Australia; 2: Indigenous people; or 3): people with a history of injecting drugs were identified and their HBV status recorded. A random sample were then invited to attend their GP for HBV testing and/or vaccination. Baseline and follow-up electronic data collection identified patients that subsequently had a consultation and HBV screening test and/or vaccination. Results From a total of 33,297 active patients, 2674 (8 %) were identified as a priority population at baseline; 2275 (85.1 %) of these patients had unknown HBV status from which 338 (14.0 %) were randomly sampled. One-fifth (n = 73, 21.6 %) of sampled patients subsequently had a GP consultation during the study period; only four people (5.5 %) were subsequently tested for HBV (CHB detected in n = 1) and none were vaccinated against HBV. Conclusion CHB infection is an important long-term health issue in Australia and strategies to increase appropriate and timely testing are required. The study was effective at identifying whether Asian-born patients and patients of Asian had been tested or vaccinated for HBV; however the intervention was not effective at increasing HBV testing.
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Affiliation(s)
- Caroline van Gemert
- Centre for Population Health, Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Julie Wang
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | | | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Douglas Boyle
- GRHANITE™ Health Informatics Unit, Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia
| | - Mark Stoove
- Centre for Population Health, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
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Rawshani A, Svensson AM, Rosengren A, Zethelius B, Eliasson B, Gudbjörnsdottir S. Impact of ethnicity on progress of glycaemic control in 131,935 newly diagnosed patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register. BMJ Open 2015; 5:e007599. [PMID: 26048210 PMCID: PMC4458585 DOI: 10.1136/bmjopen-2015-007599] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Studies on ethnic disparities in glycaemic control have been contradictory, and compromised by excessively broad categories of ethnicity and inadequate adjustment for socioeconomic differences. We aimed to study the effect of ethnicity on glycaemic control in a large cohort of patients with type 2 diabetes. SETTING We used nationwide data (mainly from primary care) from the Swedish National Diabetes Register (2002-2011) to identify patients with newly diagnosed (within 12 months) type 2 diabetes. PARTICIPANTS We included 131,935 patients (with 713,495 appointments), representing 10 ethnic groups, who were followed up to 10 years. PRIMARY AND SECONDARY OUTCOME MEASURES Progress of glycated haemoglobin (HbA1c) for up to 10 years was examined. Mixed models were used to correlate ethnicity with HbA1c (mmol/mol). The effect of glycaemic disparities was examined by assessing the risk of developing albuminuria. The impact of ethnicity was compared to that of income, education and physical activity. RESULTS Immigrants, particularly those of non-Western origin, received glucose-lowering therapy earlier, had 30% more appointments but displayed poorer glycaemic control (2-5 mmol/mol higher HbA1c than native Swedes). Probability of therapy failure was 28-111% higher for non-Western groups than for native Swedes. High-income Western groups remained below the target-level of HbA1c for 4-5 years, whereas non-Western populations never reached the target level. These disparities translated into 51-92% higher risk of developing albuminuria. The impact of ethnicity was greater than the effect of income and education, and equal to the effect of physical activity. CONCLUSIONS Despite earlier pharmacological treatment and more frequent appointments, immigrants of non-Western origin display poorer glycaemic control and this is mirrored in a higher risk of developing albuminuria.
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Affiliation(s)
- Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
- Medical Products Agency, Epidemiology, Uppsala, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
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11
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Malik MO, Govan L, Petrie JR, Ghouri N, Leese G, Fischbacher C, Colhoun H, Philip S, Wild S, McCrimmon R, Sattar N, Lindsay RS. Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia 2015; 58:716-25. [PMID: 25669630 DOI: 10.1007/s00125-015-3492-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/22/2014] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Potential differences in cardiovascular risk by ethnicity remain uncertain. We evaluated the association of ethnicity with cardiovascular disease (CVD) incidence in a large cohort of people with type 2 diabetes living in Scotland. METHODS Data from Scottish Care Information-Diabetes (SCI-Diabetes) were linked to Scottish Morbidity Records (SMR01) and National Records of Scotland data for mortality for dates between 2005 and 2011. Of 156,991 people with type 2 diabetes with coded ethnicity, 121,535 (77.4%) had no CVD at baseline (White: 114,461; Multiple Ethnic: 2,554; Indian: 797; Other Asian: 319; Pakistani: 2,250; Chinese: 387; African-Caribbean: 301 and Other: 466) and were followed up (mean ± SD: 4.8 ± 2.3 years) for the development of fatal and non-fatal CVD. RESULTS During follow-up, 16,265 (13.4%) patients developed CVD (ischaemic heart or cerebrovascular diseases). At baseline, Pakistanis were younger and had developed diabetes earlier, had higher HbA1c and longer duration of diabetes, but had lower BP, BMI, creatinine, proportion of smokers and proportion on antihypertensive therapy than whites. The age and sex adjusted HRs for CVD were HR 1.31 (CI 1.17, 1.47), p < 0.001 in Pakistanis and HR 0.66 (CI 0.47, 0.92), p = 0.014 in Chinese compared with whites. Adjusting additionally for an area measure of deprivation, duration of diabetes, conventional CVD and other risk factors, the HR for Pakistanis (HR 1.45 [CI 1.14, 1.85], p = 0.002) was significantly higher, and that for Chinese (HR = 0.58 [CI 0.24, 1.40], p = 0.228) lower, compared with whites. CONCLUSIONS/INTERPRETATION Compared with whites with type 2 diabetes, those of Pakistani ethnicity in Scotland were at increased risk of CVD, whereas Chinese were at lower risk, with these differences unexplained by known risk factors.
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Affiliation(s)
- Muhammad Omar Malik
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow, Cardiovascular Research Centre, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK
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Nishino Y, Gilmour S, Shibuya K. Inequality in diabetes-related hospital admissions in England by socioeconomic deprivation and ethnicity: facility-based cross-sectional analysis. PLoS One 2015; 10:e0116689. [PMID: 25705895 PMCID: PMC4338138 DOI: 10.1371/journal.pone.0116689] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/06/2014] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Design Facility-based cross-sectional analysis. Setting National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010–2011 (355 facilities). Participants Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. Main Outcome Measures The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. Results There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0–1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02–2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51 – 2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80 – 0.94). Conclusions More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better interventions in poorer areas, are needed to reduce these inequalities.
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Affiliation(s)
- Yoshitaka Nishino
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- * E-mail:
| | - Stuart Gilmour
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Abraham AM, Sudhir PM, Philip M, Bantwal G. Illness perceptions and perceived barriers to self-care in patients with type 2 diabetes mellitus: an exploratory study from India. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Attridge M, Creamer J, Ramsden M, Cannings‐John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD006424. [PMID: 25188210 PMCID: PMC10680058 DOI: 10.1002/14651858.cd006424.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. SEARCH METHODS A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification. MAIN RESULTS A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment. AUTHORS' CONCLUSIONS Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.
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Affiliation(s)
- Madeleine Attridge
- 3rd Floor Neuadd Meirionnydd, Cardiff UniversityCochrane Institute of Primary Care and Public HealthHeath ParkCardiffUKCF14 4YS
| | | | - Michael Ramsden
- 8th Floor, Neuadd Meirionnydd, Cardiff UniversityWales DeaneryHeath ParkCardiffUKCF14 4YS
| | - Rebecca Cannings‐John
- 4th Floor, Neuadd Meirionnydd, Cardiff UniversitySouth East Wales Trials UnitHealth ParkCardiffUKCF14 4XN
| | - Kamila Hawthorne
- 5th Floor, Cochrane Building, School of Medicine, Cardiff UniversityInstitute of Medical EducationHeath ParkCardiffUKCF14 4XN
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Morrison Z, Douglas A, Bhopal R, Sheikh A. Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes. BMJ Open 2014; 4:e004736. [PMID: 24951108 PMCID: PMC4067864 DOI: 10.1136/bmjopen-2013-004736] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/29/2014] [Accepted: 05/22/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes. DESIGN Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed. SETTING The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes. PARTICIPANTS We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers). RESULTS Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors. CONCLUSIONS Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.
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Affiliation(s)
- Zoe Morrison
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Anne Douglas
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Raj Bhopal
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Calderón-Larrañaga A, Soljak M, Cecil E, Valabhji J, Bell D, Prados Torres A, Majeed A. Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study. Diabet Med 2014; 31:657-65. [PMID: 24533786 DOI: 10.1111/dme.12413] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/04/2013] [Accepted: 02/11/2014] [Indexed: 11/29/2022]
Abstract
AIM To determine if hospital admission rates for diabetes complications (acute complications, chronic complications, no complications and hypoglycaemia) were associated with primary care diabetes management. METHODS We performed an observational study in the population in England during the period 2004-2009 (54 741 278 people registered with 8140 general practices). We used multivariable negative binomial regression to model the associations between indirectly standardized hospital admission rates for complications and primary healthcare quality, supply and access indicators, diabetes prevalence and population factors. RESULTS In multivariate regression models, increasing deprivation (incidence rate ratio: 1.0154; P < 0.001, 95% CI 1.0141-1.0166) and diabetes prevalence (incidence rate ratio: 1.0956; P < 0.001, 95% CI 1.0677-1.1241) were risk factors for admission, while most healthcare covariates, i.e. a larger practice population (incidence rate ratio 0.9999, P = 0.013, 95% CI 0.9999-0.9999), better patient-perceived urgent and non-urgent access to primary care (incidence rate ratio: 0.9989, P = 0.023; 95% CI 0.9979-0.9998 and incidence rate ratio: 0.9988; P = 0.003, 95% CI 0.9980-0.9996, respectively) and better HbA1c target achievement (incidence rate ratio: 0.9971; P < 0.001, 95% CI 0.9958-0.9984), were protective. Diabetes admissions decreased significantly during the period 2004-2009. CONCLUSIONS After controlling for population factors, better scheduled primary care access and glycaemic control were associated with lower hospital admission rates across most complications. There is little rationale to restrict primary care-sensitive condition definitions to acute complications. They should be revised to improve the usefulness of hospital admission data as an outcome measure, and to facilitate international comparisons. The risk of emergency hospital admission should be monitored routinely.
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Affiliation(s)
- A Calderón-Larrañaga
- Department of Microbiology, Preventative Medicine and Public Health, Aragon Health Research Institute, Zaragoza, Spain
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Fosse-Edorh S, Fagot-Campagna A, Detournay B, Bihan H, Gautier A, Dalichampt M, Druet C. Type 2 diabetes prevalence, health status and quality of care among the North African immigrant population living in France. DIABETES & METABOLISM 2014; 40:143-50. [PMID: 24447725 DOI: 10.1016/j.diabet.2013.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
AIM This report is an overview of type 2 diabetes (DT2) in the North African immigrant population living in France. METHODS Data were collected in two separate cross-sectional national surveys. DT2 prevalence was estimated using a population-based survey involving 13 959 people aged ≥ 45 years (EDS), while health status and quality of care were evaluated using a sample of 3894 DT2 patients (ENTRED). RESULTS Prevalence of DT2 and obesity was 14.0% [CI 95%: 9.9; 18.0] and 20.5% [15.7; 25.3], respectively, in participants born in North Africa (BNA) and 7.5% [7.0; 8.0] and 15.8% [14.7; 16.8], respectively, in those born in France (BIF). DT2 was associated with region of birth in women after adjusting for age, body mass index and income or occupation, but not after adjusting for education level. In men, DT2 was not associated with region of birth. BNA and BIF patients with diabetes frequently benefited from free medical coverage (88% vs. 84%, respectively), although BNA diabetic patients visited a general practitioner less frequently than BIF (8.5 vs. 9.0 visits/year, respectively). The percentage of BNA vs. BIF diabetes patients tested three times a year for HbA1c was lower (39% vs. 44%), while HbA1c was higher in BNA vs. BIF diabetics (> 8%: 30% vs. 15%). Ophthalmological complications were also more frequent in BNA vs. BIF patients with diabetes (25% vs. 18%, respectively). CONCLUSION The greater prevalence of DT2 in BNA women and the poorer glycaemic control observed in the BNA population overall both probably contribute to disparity in diabetes mortality compared with BIF diabetics, a fact that has been observed in previous studies.
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Affiliation(s)
- S Fosse-Edorh
- Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | - A Fagot-Campagna
- Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France; Strategy and Research Department, National Health Insurance, Île-de-France, Paris, France
| | | | - H Bihan
- Department of Endocrinology, Diabetology and Metabolic Disease, Avicenne Hospital, Paris XIII University and Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - A Gautier
- National Institute for Prevention and Health Education, Saint-Denis, France
| | - M Dalichampt
- Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - C Druet
- Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
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Negandhi PH, Ghouri N, Colhoun HM, Fischbacher CM, Lindsay RS, McKnight JA, Petrie J, Philip S, Sattar N, Wild SH. Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland. PLoS One 2013; 8:e83292. [PMID: 24358273 PMCID: PMC3865180 DOI: 10.1371/journal.pone.0083292] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland Methods We used a 2008 extract from the population-based national electronic diabetes database of Scotland. The association between ethnicity with mean glycaemic control in type 2 diabetes mellitus was examined in a retrospective cohort study, including adjustment for a number of variables including age, sex, socioeconomic status, body mass index (BMI), prescribed treatment and duration of diabetes. Results Complete data for analyses were available for 56,333 White Scottish adults, 2,535 Pakistanis, 857 Indians, 427 Chinese and 223 African-Caribbeans. All other ethnic groups had significantly (p<0.05) greater proportions of people with suboptimal glycaemic control (HbA1c >58 mmol/mol, 7.5%) compared to the White Scottish group, despite generally younger mean age and lower BMI. Fully adjusted odds ratios for suboptimal glycaemic control were significantly higher among Pakistanis and Indians (1.85, 95% CI: 1.68–2.04, and 1.62,95% CI: 1.38–1.89) respectively. Conclusions Pakistanis and Indians with type 2 diabetes mellitus were more likely to have suboptimal glycaemic control than the white Scottish population. Further research on health services and self-management are needed to understand the association between ethnicity and glycaemic control to address ethnic disparities in glycaemic control.
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Affiliation(s)
- Preeti H. Negandhi
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- * E-mail:
| | - Helen M. Colhoun
- Biomedical Research Institute, Mackenzie Building, University of Dundee, Dundee, Scotland, United Kingdom
| | - Colin M. Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom
| | - Robert S. Lindsay
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - John A. McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sam Philip
- Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sarah H. Wild
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, Scotland, United Kingdom
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Dauvrin M, Lorant V. Culturally competent interventions in Type 2 diabetes mellitus management: an equity-oriented literature review. ETHNICITY & HEALTH 2013; 19:579-600. [PMID: 24266662 DOI: 10.1080/13557858.2013.857763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Although, culturally competent (CC) interventions aim to reduce health inequalities for ethnic minorities, they have been criticized on the grounds that they increase prejudice and stereotyping. It remains unclear whether CC interventions really can reduce health inequalities among ethnic minorities. The purpose of this review is to assess whether CC interventions in the management of Type 2 diabetes mellitus (T2DM) match the recommendations to reduce health inequalities. DESIGN We identified CC interventions relating to T2DM among ethnic minority patients in the literature published between 2005 and 2011. Data were analyzed according to an equity-oriented framework. Each study was given a score based on its congruence with the reduction of health inequalities amongst ethnic minorities. RESULTS We reviewed 137 papers and found 61 studies that met the inclusion criteria. Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups. Thirty-three studies had a very low average congruence score. The highest score of congruence was achieved by one study. CONCLUSION Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities. The future of CC interventions may involve going one step further and going back to basic tenets of cultural competence: the integration of difference, whatever its source, into the delivery of fair health care for patients.
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Affiliation(s)
- Marie Dauvrin
- a Institute of Health and Society IRSS , Université catholique de Louvain , Brussels , Belgium
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Essink-Bot ML, Lamkaddem M, Jellema P, Nielsen SS, Stronks K. Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research. Eur J Public Health 2012; 23:922-6. [DOI: 10.1093/eurpub/cks170] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Doran T, Kontopantelis E, Fullwood C, Lester H, Valderas JM, Campbell S. Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework. BMJ 2012; 344:e2405. [PMID: 22511209 PMCID: PMC3328418 DOI: 10.1136/bmj.e2405] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent. DESIGN Retrospective analysis. SETTING Data for 2008-9 extracted from the clinical computing systems of general practices in England. PARTICIPANTS 8229 English family practices. MAIN OUTCOME MEASURES Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting. RESULTS The median rate of exception reporting was 2.7% (interquartile range 1.9-3.9%) overall and 0.44% (0.14-1.1%) for informed dissent, but variation in rates was wide between practices and across indicators. Common reasons for exception reporting were logistical (40.6% of exceptions), clinical contraindication (18.7%), and patient informed dissent (30.1%). Higher rates of informed dissent were associated with: higher numbers of registered patients, higher levels of local area deprivation, and failure of the practice to secure maximum remuneration in the previous year. Exception reporting increased the cost of the scheme by £30,844,500 (€36,877,700; $49,053,200) (£0.58 per patient), with two indicators accounting for a quarter of this additional cost. CONCLUSIONS The provision to exception report enables practices to exempt dissenting patients without being financially penalised. Relatively few patients were excluded for informed dissent, however, suggesting that the incentivised activities were broadly acceptable to patients.
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Affiliation(s)
- Tim Doran
- Health Sciences Research Group-Primary Care, University of Manchester, Manchester M13 9PL, UK.
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Shah BR, Cauch-Dudek K, Anand SS, Austin PC, Manuel DG, Hux JE. Absence of disparities in the quality of primary diabetes care for South Asians and Chinese in an urban Canadian setting. Diabetes Care 2012; 35:794-6. [PMID: 22323411 PMCID: PMC3308276 DOI: 10.2337/dc11-1845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/11/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether quality of diabetes care is equitable for South Asian and Chinese patients in an urban Canadian setting. RESEARCH DESIGN AND METHODS Process and intermediate measures of quality of care were compared between 246 South Asians, 170 Chinese, and 431 patients from the general population with type 2 diabetes selected from 45 family physicians' practices. RESULTS A total of 61% of Chinese achieved A1C ≤7.0% versus 45% of South Asians and 49% of the general population (P < 0.05). They were also more likely to achieve LDL cholesterol ≤2.0 mmol/L, while South Asians were more likely to achieve blood pressure ≤130/80. There was only one significant process of care deficiency: fewer foot examinations among South Asians (34 vs. 49% for the general population, P < 0.01). CONCLUSIONS Quality of diabetes care in a Canadian urban setting was equitable, with ethnic minorities somewhat more likely to achieve recommended targets than the general population.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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James GD, Baker P, Badrick E, Mathur R, Hull S, Robson J. Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004-9. J R Soc Med 2012; 105:300-8. [PMID: 22396467 DOI: 10.1258/jrsm.2012.110289] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether ethnic group differences in glycated haemoglobin (HbA1c) changed over a 5-year period in people on medication for type 2 diabetes. DESIGN Open cohort in 2004-9. SETTING Electronic records of 100 of the 101 general practices in two inner London boroughs. PARTICIPANTS People aged 35 to 74 years on medication for type 2 diabetes. MAIN OUTCOME MEASURES Mean HbA1c and proportion with HbA1c controlled to ≤ 7.5%. RESULTS In this cohort of 24,111 people, 22% were White, 58% South Asian and 17% Black African/Caribbean. From 2004 to 2009 mean HbA1c improved from 8.2% to 7.8% for White, from 8.5% to 8.0% for Black African/Caribbean and from 8.5% to 8.0% for South Asian people. The proportion with HbA1c controlled to 7.5% or less, increased from 44% to 56% in White, 38% to 53% in Black African/Caribbean and 34% to 48% in South Asian people. Ethnic group and social deprivation were independently associated with HbA1c. South Asian and Black African/Caribbean people were treated more intensively than White people. CONCLUSION HbA1c control improved for all ethnic groups between 2004-9. However, South Asian and Black African/Caribbean people had persistently worse control despite more intensive treatment and significantly more improvement than White people. Higher social deprivation was independently associated with worse control.
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Affiliation(s)
- Gareth D James
- Centre for Primary Care and Public Health, St Barts and London Hospital School of Medicine, Queen Mary University of London, 58 Turner Street, London E1 2AB, UK
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Alam R, Speed S, Beaver K. A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:155-171. [PMID: 21883609 DOI: 10.1111/j.1365-2524.2011.01027.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible avenues towards improved access to healthcare information and services for the Bangladeshi population.
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Affiliation(s)
- Rahul Alam
- School of Nursing, Midwifery & Social Work, University of Manchester, University Place, Manchester, UK.
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Bhopal RS. Research agenda for tackling inequalities related to migration and ethnicity in Europe. J Public Health (Oxf) 2012; 34:167-73. [PMID: 22366715 DOI: 10.1093/pubmed/fds004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research. Active involvement of migrant and ethnic minority populations in European population health research is necessary, for data show important inequalities but evidence, particularly on effectiveness, is sparse and strategic overviews rarer still. Ethnically disaggregated health surveillance systems are developing slowly, and pragmatically, often using country of birth. The principles to adopt, given the gaps between the ideal and the current reality, need wider discussion. Ethics may provide both principles and impetus. Doing no harm, doing good, respecting the research participants' autonomy are good starting points. More emphasis is needed on justice, fairness and equality, participation and communicating effectively. Ethnic minority groups are willing participants in trials once linguistic and trust-related barriers are overcome, though recruitment costs are higher. Guidelines and strategies by European bodies with research funding or enforcement responsibilities are needed. The research community needs an infrastructure within which to collect and utilize evidence. Research can help migrant and ethnic minority groups to participate more fully in our multi-ethnic societies.
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Affiliation(s)
- Raj S Bhopal
- Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
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Bhopal RS, Bansal N, Steiner M, Brewster DH. Does the 'Scottish effect' apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study. BMJ Open 2012; 2:bmjopen-2012-001957. [PMID: 23012329 PMCID: PMC3467629 DOI: 10.1136/bmjopen-2012-001957] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although ethnic group variations in cancer exist, no multiethnic, population-based, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in all-cancer, and lung, colorectal, breast and prostate cancers. DESIGN, SETTING, POPULATION, MEASURES AND ANALYSIS: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups. RESULTS For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups. CONCLUSIONS The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of cost-effectiveness of screening, given comparatively low cancer rates.
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Affiliation(s)
- Raj S Bhopal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Narinder Bansal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Markus Steiner
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Environmental & Occupational Medicine, Section of Population Health, University of Aberdeen, Aberdeen, UK
| | - David H Brewster
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Information Services Division, NHS Scotland National Services, Edinburgh, UK
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Singh H, Cinnirella M, Bradley C. Support systems for and barriers to diabetes management in South Asians and Whites in the UK: qualitative study of patients' perspectives. BMJ Open 2012; 2:bmjopen-2012-001459. [PMID: 23151392 PMCID: PMC3532968 DOI: 10.1136/bmjopen-2012-001459] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To explore experiences of UK-based South Asian and White patients with diabetes in relation to their support systems for and barriers to diabetes management. DESIGN Qualitative study (semistructured interviews analysed using a form of Interpretative Phenomenological Analysis). PARTICIPANTS 20 outpatients with diabetes (12 British South Asians and 8 British Whites) with either good or poor glycaemic control. SETTING Hillingdon Hospital, Uxbridge, UK. RESULTS Qualitative analysis revealed distinct themes for the two ethnic groups. For the South Asian participants, challenges surrounding diet management and social stigma attached to having diabetes were the two predominant barriers to effective diabetes management. Support from immediate family members was commonly reported as a strong support system for optimising diabetes management by the South Asian sample in addition to the perceived positive impact of religion (healing power of prayer), the valuable informational support from their diabetes-care team, patient leaflets and diabetes magazines. Similar to the South Asians, adhering to dietary recommendations was the most difficult aspect of diabetes management for the White participants followed by the inconveniences surrounding injecting insulin. The hospital diabetes-care team was considered as the most effective support system for diabetes management by the White sample and interestingly, this was the only dominant theme in their reported sources of support. CONCLUSIONS Both South Asian and White participants emphasised adherence to dietary recommendations as the most difficult aspect of living with diabetes. In addition, social stigma attached to diabetes was a prominent concern among South Asian participants that seemed to have a significant negative impact on their diabetes control and overall management. Given South Asian patients' reliance on their family for the management of their condition, interventions targeting improved diabetes outcomes in this population may prove more successful if they are designed to involve significant family members.
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Affiliation(s)
- Harsimran Singh
- Department of Psychiatry and Neurobehavioral Sciences, Behavioural Medicine Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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James GD, Baker P, Badrick E, Mathur R, Hull S, Robson J. Type 2 diabetes: a cohort study of treatment, ethnic and social group influences on glycated haemoglobin. BMJ Open 2012; 2:bmjopen-2012-001477. [PMID: 23087015 PMCID: PMC3488709 DOI: 10.1136/bmjopen-2012-001477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To assess whether in people with poorly controlled type 2 diabetes (HbA1c>7.5%) improvement in HbA1c varies by ethnic and social group. DESIGN Prospective 2-year cohort of type 2 diabetes treated in general practice. SETTING AND PARTICIPANTS All patients with type 2 diabetes in 100 of the 101 general practices in two London boroughs. The sample consisted of an ethnically diverse group with uncontrolled type 2 diabetes aged 37-71 years in 2007 and with HbA1c recording in 2008-2009. OUTCOME MEASURE Change from baseline HbA1c in 2007 and achievement of HbA1c control in 2008 and 2009 were estimated for each ethnic, social and treatment group using multilevel modelling. RESULTS The sample consisted of 6104 people; 18% were white, 63% south Asian, 16% black African/Caribbean and 3% other ethnic groups. HbA1c was lower after 1 and 2 years in all ethnic groups but south Asian people received significantly less benefit from each diabetes treatment. After adjustment, south Asian people were found to have 0.14% less reduction in HbA1c compared to white people (95% CI 0.04% to 0.24%) and white people were 1.6 (95% CI 1.2 to 2.0) times more likely to achieve HbA1c controlled to 7.5% or less relative to south Asian people. HbA1c reduction and control in black African/Caribbean and white people did not differ significantly. There was no evidence that social deprivation influenced HbA1c reduction or control in this cohort. CONCLUSIONS In all treatment groups, south Asian people with poorly controlled diabetes are less likely to achieve controlled HbA1c, with less reduction in mean HbA1c than white or black African/Caribbean people.
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Affiliation(s)
- Gareth D James
- Centre for Primary Care and Public Health, St Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Vandenheede H, Deboosere P, Stirbu I, Agyemang CO, Harding S, Juel K, Rafnsson SB, Regidor E, Rey G, Rosato M, Mackenbach JP, Kunst AE. Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change. Eur J Epidemiol 2011; 27:109-17. [PMID: 22167294 DOI: 10.1007/s10654-011-9638-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/01/2011] [Indexed: 12/16/2022]
Abstract
The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries. To assess migrant diabetes mortality, we used direct standardization and Poisson regression. First, migrant mortality was estimated for each country separately. Then, we merged the data from all mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations. Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests that socio-economic change may be one of the key aetiological factors.
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Affiliation(s)
- Hadewijch Vandenheede
- Interface Demography, Department of Social Research, Vrije Universiteit Brussel, 5 Pleinlaan, 1050 Brussels, Belgium.
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Douglas A, Bhopal RS, Bhopal R, Forbes JF, Gill JMR, Lawton J, McKnight J, Murray G, Sattar N, Sharma A, Tuomilehto J, Wallia S, Wild SH, Sheikh A. Recruiting South Asians to a lifestyle intervention trial: experiences and lessons from PODOSA (Prevention of Diabetes & Obesity in South Asians). Trials 2011; 12:220. [PMID: 21978409 PMCID: PMC3201899 DOI: 10.1186/1745-6215-12-220] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/06/2011] [Indexed: 11/23/2022] Open
Abstract
Background Despite the growing emphasis on the inclusion of ethnic minority patients in research, there is little published on the recruitment of these populations especially to randomised, community based, lifestyle intervention trials in the UK. Methods We share our experience of recruitment to screening in the PODOSA (Prevention of Diabetes and Obesity in South Asians) trial, which screened 1319 recruits (target 1800) for trial eligibility. A multi-pronged recruitment approach was used. Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practices. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations. Participants were encouraged to refer friends and family throughout the recruitment period. Results Health care professionals referred only 55 potential participants. The response to written invitations via general practitioners was 5.2%, lower than reported in other general populations. Community orientated, personal approaches for recruitment were comparatively effective yielding 1728 referrals (82%) to the screening stage. Conclusions The PODOSA experience shows that a community orientated, personal approach for recruiting South Asian ethnic minority populations can be successful in a trial setting. We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches. Researchers should consider prioritising approaches that minimise interference with professionals' work and, particularly in the current economic climate, keep costs to a minimum. The lessons learned in PODOSA should contribute to future community based trials in South Asians. Trial Registration Current Controlled Trials ISRCTN25729565
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Affiliation(s)
- Anne Douglas
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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Vandenheede H, Deboosere P, Gadeyne S, De Spiegelaere M. The associations between nationality, fertility history and diabetes-related mortality: a retrospective cohort study in the Brussels-Capital Region (2001-2005). J Public Health (Oxf) 2011; 34:100-7. [PMID: 21665909 DOI: 10.1093/pubmed/fdr045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The relationship between women's parity and diabetes mortality has been investigated in several studies, with mixed results. This study aims to establish if parity and age at first birth are associated with diabetes-related mortality and if these factors contribute to variations in diabetes-related mortality among women with different nationalities. METHODS Data of the 2001 census are linked to registration records of all deaths and emigrations (period 2001-2005). The study population comprises all female inhabitants of the Brussels-Capital Region aged 45-74 of either Belgian or North African nationality (n = 108 296). Age-standardized mortality rates (direct standardization) and mortality rate ratios (Poisson's regression) are computed. RESULTS Both parity and age at first birth are associated with diabetes-related mortality. Highest risks of dying from diabetes are observed among grandmultiparous women and teenage mothers. Differences in diabetes-related mortality according to nationality are observed. Age-standardized diabetes mortality rates are higher in North African [ASMR = 417.4/100,000; 95% confidence interval (CI) 227.2-607.7] than in Belgian women (ASMR = 184.0/100,000; 95% CI 157.3-210.8). Taking parity, age at first birth and education into account, these differences largely disappear. CONCLUSIONS Reproductive factors are associated with diabetes-related mortality and play an important part in the higher diabetes-related mortality of North African compared with Belgian women.
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Affiliation(s)
- Hadewijch Vandenheede
- Vrije Universiteit Brussel, Department of Social Research, Interface Demography, Brussels 1050, Belgium.
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Gill JMR, Bhopal R, Douglas A, Wallia S, Bhopal R, Sheikh A, Forbes JF, McKnight J, Sattar N, Murray G, Lean MEJ, Wild SH. Sitting time and waist circumference are associated with glycemia in U.K. South Asians: data from 1,228 adults screened for the PODOSA trial. Diabetes Care 2011; 34:1214-8. [PMID: 21464463 PMCID: PMC3114490 DOI: 10.2337/dc10-2313] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the independent contributions of waist circumference, physical activity, and sedentary behavior on glycemia in South Asians living in Scotland. RESEARCH DESIGN AND METHODS Participants were 1,228 (523 men and 705 women) adults of Indian or Pakistani origin screened for the Prevention of Type 2 Diabetes and Obesity in South Asians (PODOSA) trial. All undertook an oral glucose tolerance test, had physical activity and sitting time assessed by International Physical Activity Questionnaire, and had waist circumference measured. RESULTS Mean ± SD age and waist circumference were 49.8 ± 10.1 years and 99.2 ± 10.2 cm, respectively. One hundred ninety-one participants had impaired fasting glycemia or impaired glucose tolerance, and 97 had possible type 2 diabetes. In multivariate regression analysis, age (0.012 mmol ⋅ L⁻¹ ⋅ year⁻¹ [95% CI 0.006-0.017]) and waist circumference (0.018 mmol ⋅ L⁻¹ ⋅ cm⁻¹ [0.012-0.024]) were significantly independently associated with fasting glucose concentration, and age (0.032 mmol ⋅ L⁻¹ ⋅ year⁻¹ [0.016-0.049]), waist (0.057 mmol ⋅ L⁻¹ ⋅ cm⁻¹ [0.040-0.074]), and sitting time (0.097 mmol ⋅ L⁻¹ ⋅ h⁻¹ ⋅ day⁻¹ [0.036-0.158]) were significantly independently associated with 2-h glucose concentration. Vigorous activity time had a borderline significant association with 2-h glucose concentration (-0.819 mmol ⋅ L⁻¹ ⋅ h⁻¹ ⋅ day⁻¹ [-1.672 to 0.034]) in the multivariate model. CONCLUSIONS These data highlight an important relationship between sitting time and 2-h glucose levels in U.K. South Asians, independent of physical activity and waist circumference. Although the data are cross-sectional and thus do not permit firm conclusions about causality to be drawn, the results suggest that further study investigating the effects of sitting time on glycemia and other aspects of metabolic risk in South Asian populations is warranted.
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Affiliation(s)
- Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Benhalima K, Wilmot E, Khunti K, Gray LJ, Lawrence I, Davies M. Type 2 diabetes in younger adults: clinical characteristics, diabetes-related complications and management of risk factors. Prim Care Diabetes 2011; 5:57-62. [PMID: 20851071 DOI: 10.1016/j.pcd.2010.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 08/01/2010] [Indexed: 10/19/2022]
Abstract
AIM To describe the clinical characteristics and risk factors of adults <35 years with type 2 diabetes (T2DM). METHODS Observational study of 185 younger adults attending a specialist diabetes clinic. RESULTS In this cohort 65% were female, 51% Caucasian, 43% South Asian. Characteristics at presentation: age 24 ± 5.5 years, BMI 33 ± 7.6 kg/m(2) and HbA1c 9.0% ± 2.3. Follow up of 3.2 ± 2.8 years with a diabetes duration of 4.5 ± 3.6 years. HbA1c had improved compared with diagnosis (8.3 ± 2.2% vs. 9.0% ± 2.3%, p<0.0001), but 63% still had an HbA1c>7%. Oral anti-diabetic drugs were used in 72%, insulin alone in 19% and both in 26%. 41% had a BP ≥ 140/80 mmHg, 78% total cholesterol >4 mmol/l, 63% LDL >2 mmol/l, 56% triglycerides >1.7 mmol/l. From diagnosis only the cholesterol and LDL improved significantly, with a modest increase in primary prevention therapy (statin 12-26%, p<0.0001, anti-hypertensives 16-29%, p<0.0001, aspirin 8-12%, p=0.18). 13% had retinopathy, 21% microalbuminuria. 46% had not been reviewed within the past year. CONCLUSIONS This group represents an extreme phenotype with a high prevalence of insufficiently treated metabolic risk factors. There is need for tailored management strategies to engage and aggressively manage this high-risk group.
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Affiliation(s)
- Katrien Benhalima
- Department of Diabetes Research, University Hospital of Leicester, Victoria Building Level 1, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom.
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Abstract
The role of nutrition is especially important in certain ‘lifestyle’ diseases that impact disproportionately on ethnic minority populations. The aim of this paper is to review the evidence of risk, health outcomes and interventions for certain diseases that affect the UK's largest ethnic minority group (South Asians) in order to help professionals better address the needs of this diverse population. Research evidence is presented on factors influencing access to services by ethnic minority populations and the changing UK policy background for public health and preventive care. The available research base on obesity, diabetes and CVD is discussed. Conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth; all making preventive care important. Obesity is a major risk factor and it appears that BMI thresholds may need to be lower for South Asians. Targeted interventions to improve diet and outcomes in the South Asian population also appear promising. Recent moves to promote access to evidence of ethnicity and health and to improve the cultural competence of organisations are discussed. Health professionals will increasingly need to promote lifestyle changes in a manner that meets the needs of a diverse population in order to address future public health challenges. Nutritionists and other professionals will need to ensure that interventions are culturally appropriate and involve engagement with extended family members and communities.
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Samsudeen BS, Douglas A, Bhopal RS. Challenges in recruiting South Asians into prevention trials: health professional and community recruiters' perceptions on the PODOSA trial. Public Health 2011; 125:201-9. [PMID: 21450322 DOI: 10.1016/j.puhe.2011.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 12/23/2010] [Accepted: 01/21/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recruitment of ethnic minority groups into trials is important. This was studied from the recruiters' perspective in the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial. METHODS Semi-quantitative questionnaire survey of all 22 health professionals and 27 community workers involved in Edinburgh and Glasgow. Numbers and proportions were tabulated, while free-text responses were grouped into themes. RESULTS The response rate was 40/49 (82%). In the closed questions, family responsibilities, prior general practitioner screening and low interest were the main factors reported by recruiters as hindering referrals (each 28%), followed by fear of needle pricks and finding out their diabetes status (each 23%). The importance of the prevention of diabetes (60%), explaining the trial in a South Asian language (46%), verbal dialogue (43%) and the recruiter's personal relationship with the recruitee (40%) favoured referrals. Health professionals' perceived strength was their knowledge of diabetes (66%), and community workers' strength was explaining the trial in South Asian languages (65%). Strategies to improve recruitment included stronger partnership between researchers and community organizations. The open-ended response identified seven main themes: (1) shortage of recruiters' and recruitees' time; (2) poor understanding of the trial by recruitees; (3) lack of knowledge about the disease among recruitees; (4) lack of motivation and interest among recruitees; (5) delay in receiving appointments from the PODOSA team; (6) mistrust of research; and (7) narrow entry criteria. CONCLUSION These insights into recruiters' perspectives should help trialists improve participation by ethnic minority populations.
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Affiliation(s)
- B S Samsudeen
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK
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Vandenheede H, Lammens L, Deboosere P, Gadeyne S, De Spiegelaere M. Ethnic differences in diabetes-related mortality in the Brussels-Capital Region (2001-05): the role of socioeconomic position. Int J Public Health 2011; 56:533-9. [PMID: 21302129 DOI: 10.1007/s00038-011-0235-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/06/2011] [Accepted: 01/23/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine if and to what extent ethnic differences in diabetes-related mortality are associated with differences in education and housing status. METHODS The data consist of a cohort study linking the 2001 census to emigration and mortality data for the period 2001-05. The study population comprises all Belgian and North African inhabitants of the Brussels-Capital Region (BCR) aged 25-74. Age-standardized mortality rates (ASMRs) (direct standardization) and mortality rate ratios (MRRS) (Poisson regression) are computed. RESULTS North Africans have a higher diabetes-related mortality compared to Belgians. The ASMRs for North African and Belgian women are 54.8 (95% confidence interval (CI) 31.5-78.2) and 23.8 (95% CI 20.3-27.3), respectively. These differences in diabetes-related mortality largely disappear when differences in education are taken into account. The MRRs for North African versus Belgian origin drop from 1.62 (95% CI 1.11-2.37) to 1.19 (95% CI 0.73-1.93) in men and from 3.35 (95% CI 2.08-5.41) to 1.88 (95% CI 0.95-3.69) in women. CONCLUSIONS Differences in education play an important part in the excess diabetes-related mortality among North Africans in the BCR.
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Affiliation(s)
- Hadewijch Vandenheede
- Interface Demography, Department of Social Research, Faculty of Economic, Political and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, 2 Pleinlaan, 1050 Brussels, Belgium.
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Khan NA, Wang H, Anand S, Jin Y, Campbell NRC, Pilote L, Quan H. Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care 2011; 34:96-101. [PMID: 20978094 PMCID: PMC3005449 DOI: 10.2337/dc10-0865] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes guidelines recommend aggressive screening for type 2 diabetes in Asian patients because they are considered to have a higher risk of developing diabetes and potentially worse prognosis. We determined incidence of diabetes and risk of death or macrovascular complications by sex among major Asian subgroups, South Asian and Chinese, and white patients with newly diagnosed diabetes. RESEARCH DESIGN AND METHODS Using population-based administrative data from British Columbia and Alberta, Canada (1997-1998 to 2006-2007), we identified patients with newly diagnosed diabetes aged ≥35 years and followed them for up to 10 years for death, acute myocardial infarction, stroke, or hospitalization for heart failure. Ethnicity was determined using validated surname algorithms. RESULTS There were 15,066 South Asian, 17,754 Chinese, and 244,017 white patients with newly diagnosed diabetes. Chinese women and men had the lowest incidence of diabetes relative to that of white or South Asian patients, who had the highest incidence. Mortality in those with newly diagnosed diabetes was lower in South Asian (hazard ratio 0.69 [95% CI 0.62-0.76], P < 0.001) and Chinese patients (0.69 [0.63-0.74], P < 0.001) then in white patients. Risk of acute myocardial infarction, stroke, or heart failure was similar or lower in the ethnic groups relative to that of white patients and varied by sex. CONCLUSIONS The incidence of diagnosed diabetes varies significantly among ethnic groups. Mortality was substantially lower in South Asian and Chinese patients with newly diagnosed diabetes than in white patients.
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Affiliation(s)
- Nadia A Khan
- Division of General Internal Medicine, University of British Columbia, British Columbia, Canada.
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Dominguez H, Schramm TK, Gislason GH, Norgaard ML, Raunsø J, Abildstrøm SZ, Kober L, Poulsen HE, Torp-Pedersen CT. National Background is Associated with Disparities in Initiation and Persistence to Statin Treatment in Subjects with Diabetes in Denmark. Front Pharmacol 2010; 1:142. [PMID: 21833181 PMCID: PMC3153016 DOI: 10.3389/fphar.2010.00142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/02/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the effects of statin use over the last 10 years among diabetic patients who initiated glucose-lowering medications (GLMs) in Denmark. METHODS we identified all Danish citizens 30 years and older who claimed their first GLM between 1997 and 2006, with follow-up until 2007. Use of medications, national background, income, and hospitalizations were obtained by cross-linkage of national registries in Denmark. We analyzed factors related to initiation and interruption of statin treatment. The analyses included country of birth, citizenship and, as proxy for ethnic origin, we constructed variables based on both the subjects and on their parent's country of birth. Countries were grouped as Denmark, Western countries, Eastern countries, and Africa. RESULTS the cohort included 143,625 subjects. Compared with persons of Danish origin, the initiation of a statin medication during follow-up was significantly lower among patients of non-Danish origin: Odds ratio for subjects of Eastern origin 0.61 [CI 0.49-0.76] and 0.37 for subjects of African origin, [CI 0.24-0.59], both p < 0.001. The risk of interrupting statin treatment once it had been initiated was also higher in these groups (hazard ratio 2.03, [CI 1.91-2.17] for Eastern subjects and 1.94, [CI 1.63-2.32] for African subjects, both p < 0.0001). Combination of ethnic parameters to refine identification of the cohort led to the same conclusions as the analysis based only on country of birth or citizenship respectively. CONCLUSION diabetes patients of African and Eastern origin in Denmark have less chance of being treated with a statin than those of western and Danish origin despite similar access to the Danish health care system.
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Affiliation(s)
- Helena Dominguez
- Department of Cardiology, Herlev Hospital, Copenhagen UniversityHerlev, Denmark
| | - Tina Kenn Schramm
- The Heart Center, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | | | - Mette Lykke Norgaard
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
| | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
| | - Steen Zabell Abildstrøm
- National Institute of Public Health, University of Southern DenmarkCopenhagen, Denmark
- Clinical Pharmacology Q7642, RigshospitaletCopenhagen, Denmark
| | - Lars Kober
- The Heart Center, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Clinical Pharmacology Q7642, RigshospitaletCopenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg HospitalCopenhagen, Denmark
- Faculty of Health Sciences, University of CopenhagenDenmark
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
- Faculty of Health Sciences, University of CopenhagenDenmark
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Hawthorne K, Robles Y, Cannings-John R, Edwards AGK. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med 2010; 27:613-23. [PMID: 20546277 DOI: 10.1111/j.1464-5491.2010.02954.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To determine if culturally appropriate health education is more effective than 'usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA(1c), blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA(1c) showed an improvement at 3 months [weighted mean difference (WMD) -0.32%, 95% confidence interval (CI) -0.63, -0.01] and 6 months post intervention (WMD -0.60%, 95% CI -0.85, -0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than 'usual' health education in improving HbA(1c) and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research.
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Affiliation(s)
- K Hawthorne
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
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Lorant V, Bhopal R. Comparing policies to tackle ethnic inequalities in health: Belgium 1 Scotland 4. Eur J Public Health 2010; 21:235-40. [PMID: 20478836 DOI: 10.1093/eurpub/ckq061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ethnic-minority health is a public health priority in Europe. This study compares strategies for tackling ethnic inequalities in health from two countries, Scotland and Belgium. METHODS We compared the countries using the Whitehead framework. Official policy documents were retrieved and reviewed and two databases related to immigrant health policies were also used. Ethnic inequalities in health were compared using the UK and Belgian Censuses of 2001. We analysed the recognition of the problem, the policies and the services and described ethnic health inequalities. RESULTS Scotland has recognized the problem of ethnic inequalities in health, thanks to better data and the Scottish Government has come up with a bold strategy. Belgium is a later starter, unable to properly monitor ethnic inequalities. In addition, there is no clear government commitment to tackling either health inequalities or ethnic inequalities in health. Both countries provide health-care services to ethnic minority groups through the mainstream services, although ethnic minority groups have more choice in Belgium than in Scotland. Overall, ethnic heath inequalities are lower in Scotland than in Belgium. CONCLUSION Scotland has provided a more advanced and comprehensive response to tackling ethnic inequalities in health than Belgium. It has acknowledged that discrimination exists and that ethnic minority groups may have different needs. Belgium still assumes non-discrimination in health care and effectively denies the need for policy to tailor services to meet these needs. In Scotland, public organizations have been made accountable for promoting equality in health. This is an important contribution to European health policy.
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Affiliation(s)
- Vincent Lorant
- Institute for Health and Society, Université Catholique de Louvain, clos chapelle aux champs 30.41, 1200 Bruxelles, Belgium.
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Verma A, Birger R, Bhatt H, Murray J, Millett C, Saxena S, Banarsee R, Gnani S, Majeed A. Ethnic disparities in diabetes management: a 10-year population-based repeated cross-sectional study in UK primary care. J Public Health (Oxf) 2010; 32:250-8. [PMID: 20064875 DOI: 10.1093/pubmed/fdp114] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There has been little research on the impact of quality improvement initiatives on ethnic disparities in diabetes management in the UK. METHODS Population-based, repeated cross-sectional survey of recorded measurements, prescribing and achievement of treatment targets among 4309 patients with diabetes mellitus using electronic medical records from 26 general practices in North-West London from 1997 to 2006. RESULTS Proportions of patients having their blood pressure (BP), cholesterol and HbA1c measured and recorded increased over the study period [from 50.6% to 87.0% (P < 0.0001), 17.0% to 76.7% (P < 0.0001) and 32.9% to 74.1% (P < 0.0001), respectively]. However, some ethnic differences remained. Black patients with diabetes were less likely to achieve target BP (<140/80 mmHg) than the white group [2006 age-sex adjusted odds ratio (AOR), 0.65; 95% confidence interval (CI), 0.51-0.83]. South Asians were found to have better lipid target control (2006 AOR, 1.57; CI, 1.23-2.00), were more likely to receive oral hypoglycaemic agents (2006 AOR, 2.27; CI, 1.79-2.86) but less likely to receive insulin (2006 AOR, 0.54; CI, 0.42-0.69) than the white group. CONCLUSIONS Although ethnic disparities persist in diabetes management in this study population, these are starting to be addressed, particularly in the South Asian group. All ethnic groups have benefited from recent quality initiatives in the UK.
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Affiliation(s)
- Anju Verma
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, 3rd floor Reynolds Building, St Dunstan's Road, London, UK.
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