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Shahrestanaki E, Mohammadian Khonsari N, Seif E, Baygi F, Ejtahed HS, Sheidaei A, Djalalinia S, Magliano DJ, Qorbani M. The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies. Front Public Health 2024; 12:1305304. [PMID: 38827607 PMCID: PMC11140097 DOI: 10.3389/fpubh.2024.1305304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/06/2024] [Indexed: 06/04/2024] Open
Abstract
Background With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels. Methods In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates. Results A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly. Conclusion Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.
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Affiliation(s)
- Ehsan Shahrestanaki
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Seif
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research & Technology, Ministry of Health & Medical Education, Tehran, Iran
| | - Dianna J. Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Soós R, Bakó C, Gyebrovszki Á, Gordos M, Csala D, Ádám Z, Wilhelm M. Nutritional Habits of Hungarian Older Adults. Nutrients 2024; 16:1203. [PMID: 38674893 PMCID: PMC11053580 DOI: 10.3390/nu16081203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many nutritional changes that come with aging, mostly as consequences of health regression. Malnutrition and overweight often start with inadequate food consumption, followed by alterations in biochemical indices and body composition. In our study, we aimed to analyze the feeding habits and energy and nutrient intake of a Hungarian elderly population, focusing on macronutrient, water, fruit, and vegetable consumption while searching for possible nutritional factors leading to NCD and many other chronic diseases in this population. Two questionnaires were used. These were the Mini Nutritional Assessment (MNA) and one asking about nutritional habits, and a 3-day feeding diary was also filled. Subjects (n = 179, 111; females (F), 68 males (M), older than 50 years were recruited. Based on MNA results, 78 adults (43.57% of the studied population) were malnourished or at risk of malnutrition, although, according to BMI categories, 69% were overweight and 7.3% were obese among M, while 42.3% were overweight among F. The average daily meal number was diverse. The amount of people consuming fruit (11.7%) and vegetables (8.93%) several times a day was extremely low (15.3% of F and 4.4% of M). Daily fruit consumption in the whole sample was 79.3%. Overall, 36.3% consumed 1 L of liquid and 0.5 L of consumption was found in 15.1% of participants. A significant gender difference was found in water consumption, with F drinking more than M (p ≤ 0.01). In our sample, 27.93% of the respondents took dietary supplements. Further analysis and research are needed to explore the specific health implications of and reasons behind these findings.
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Affiliation(s)
- Rita Soós
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Csilla Bakó
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Gyebrovszki
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Mónika Gordos
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Dávid Csala
- Doctoral School of Biology and Sportbiology, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary; (Á.G.); (D.C.)
| | - Zoltán Ádám
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Pécs, 7624 Pécs, Hungary;
- Wnt-Signaling Research Group, Szentagothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Márta Wilhelm
- Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, 7624 Pécs, Hungary;
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Adhikari P, Sriyuktasuth A, Phligbua W. Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:489-497. [PMID: 37901380 PMCID: PMC10600700 DOI: 10.33546/bnj.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Diabetes mellitus (DM) is an emerging global public health challenge worldwide, including Nepal. Social determinants of health (SDOH) play a major role in glycemic control among persons with type 2 DM (T2DM). However, little is known about the association between SDOH and glycemic control among individuals with T2DM in Nepal. Objective This study aimed to identify the level of glycemic control and SDOH associated with glycemic control among Nepalese with T2DM. Methods This cross-sectional study was conducted at a tertiary hospital in Kathmandu, Nepal, among 135 Nepalese diagnosed with T2DM who attended follow-up appointments. Convenience sampling and inclusion criteria were utilized for participant selection. Data were collected from April to June 2021 using validated scales. Descriptive statistics, Chi-square test, and binary logistic regression were employed to analyze the data. Results The mean age of the participants in this study was 53.84 (SD = 11.78) years, and the average monthly household income was 567.64 (SD = 362.30) USD. The majority of the participants (77.8%) were literate and had no health insurance coverage (73.3%). Approximately 64.4% of the participants showed suboptimal glycemic control indicated by glycated hemoglobin (HbA1c) ≥7%. The significant determinants of good glycemic control included monthly household income of >850 USD (odds ratio [OR] = 12.20, 95% confident interval [CI] = 1.76-84.61, p = 0.011) and 341-600 USD (OR = 7.64, 95% CI 1.35-42.98, p = 0.021), being literate (OR = 6.37, 95% CI = 1.65-24.49, p = 0.007), having health insurance (OR = 5.82, 95% CI = 1.49-22.65, p = 0.011), sufficient health literacy (OR = 3.46, 95% CI = 1.10-10.83, p = 0.03), and high (OR = 16.17, 95% CI = 2.36-110.67, p = 0.005) and moderate (OR = 7.02, 95% CI = 1.26-39.07, p = 0.026) food availability, respectively. Conclusion The study revealed suboptimal glycemic control in Nepalese with T2DM. This study presents essential social determinants of glycemic control in this population. Therefore, healthcare providers, particularly nurses, should pay more attention to assessing social determinants and provide targeted interventions to patients with T2DM who have low income, are illiterate, have no health insurance coverage, have insufficient health literacy, and have low resources for food availability.
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Affiliation(s)
- Prava Adhikari
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
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Tayyem R, Hamdan A, Alhmmadi K, Eissa Y, Al-Adwi M, Al-Haswsa Z, Bawadi H, Shi Z. Association of Glycemic Control With Different Diets Followed by Patients With Type 2 Diabetes: Findings From Qatar Biobank Data. Front Nutr 2022; 9:813880. [PMID: 35619957 PMCID: PMC9127728 DOI: 10.3389/fnut.2022.813880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes mellitus type 2 (T2DM) is one of the most common diseases worldwide. Unhealthy dietary habits may lead to T2DM, which is also influenced by the extent of education and knowledge of appropriate diets for this disease. Aim This study aims to highlight the possible association between following different types of diet (low-fat diet, low-calorie diet, low-salt diet, and more than one diet) and glycemic control among Qatari and long-term resident patients with T2DM. Methods This study is secondary data analysis. Qatar Biobank (QBB) data on 2448 T2DM patients aged 18-60 years were obtained. The first group included participants with HbA1C <7%, while the second included those with HbA1c ≥ 7%. Results The results of the association of glycemic control with different diets followed by patients with type 2 diabetes were adjusted in four models. In the 4th model (adjusted for gender, age, sociodemographic, anthropometric, dietary habits, comorbidities, and medications), results showed that poor patients with poor glycemic control have higher odds [OR 1.90; CI (1-3.63)] of following a low-salt diet. The same observation was found in the low-fat diet [OR 1.73; CI (1.06-3.07)]. However, patients following more than one diet showed lower odds of having poor glycemic control for about 32% [OR.69; CI (0.48-0.98)]. Conclusion Diet and lifestyle are vital factors that can affect HbA1C levels. The findings of this secondary analysis showed that better glycemic control of the patients was observed in patients following more than diet from the studied diets.
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Affiliation(s)
- Reema Tayyem
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha, Qatar
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Li Y, Jiang Y, Lin J, Wang D, Wang C, Wang F. Prevalence and associated factors of diabetes mellitus among individuals aged 18 years and above in Xiaoshan District, China, 2018: a community-based cross-sectional study. BMJ Open 2022; 12:e049754. [PMID: 35296469 PMCID: PMC8928303 DOI: 10.1136/bmjopen-2021-049754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE With the rapid development of the Chinese economy, Xiaoshan District, Zhejiang Province has experienced urbanisation, population ageing and significant lifestyle changes, so diabetes mellitus (DM) has attracted more attention. This study aimed to evaluate the prevalence of DM and its risk factors among individuals aged 18 years and above in the district. STUDY DESIGN AND METHODS A community-based cross-sectional study was carried out in Xiaoshan, China from 1 March to 31 August 2018. A multistage sampling method was used. Sociodemographic and behavioural characteristics were collected using a combination of centralised surveys and household surveys. Anthropometric parameters were measured with standardised techniques and calibrated equipment. Venous blood samples were obtained after at least 8 hours of fasting to determine the level of fasting blood glucose (FBG) and blood lipids. A standard 2-hour 75 g oral glucose tolerance test was also given if 6.1 mmol/L≤FBG<7.0 mmol/L. Univariate and multivariate logistic regression analyses were used to assess the associated factors of DM. RESULTS The overall prevalence of DM was 12.47%, and the proportion of previously undiagnosed DM (UDM) was 48.66%. The prevalence of pre-diabetes was 10.92%. Age, family history of DM (FHDM), obesity, abdominal obesity, systolic blood pressure (SBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were significantly associated with DM. CONCLUSIONS This study found a high prevalence of DM and pre-diabetes, especially a high prevalence of UDM among adults. The associated risk factors identified for DM were age, FHDM, obesity, abdominal obesity, SBP, TG and HDL-C.
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Affiliation(s)
- Yurong Li
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuanyuan Jiang
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Junying Lin
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Dongfei Wang
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Chunli Wang
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Fenjuan Wang
- Zhejiang Provincial Health Bureau, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Haghravan S, Mohammadi-Nasrabadi F, Rafraf M, Asghari Jafarabadi M. Evaluation of the effects of the national diabetes control and prevention program on a sample of iranian people with type 2 diabetes. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-211528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes prevention programs have been developed in the different countries and it is therefore necessary to gain a better understanding of factors affecting the effectiveness of these programs for each society. Accordingly, the purpose of this study was to evaluate the effect of the National Diabetes Control and Prevention Program (NDCPP) on the biochemical and anthropometric indices among a sample of Iranian patients with type 2 diabetes mellitus (T2DM). A total of 384 patients with T2DM from the primary health care system of Tehran and Tabriz cities during January to June 2020, were included in the study. A two-part questionnaire consisting of items related to socio-economic and demographic characteristics was used and biochemical and anthropometric indices were measured at the beginning and the end of the 3-month intervention period. There was a significant difference in fasting blood sugar (FBS), hemoglobin glycosides (HbA1 C), systolic blood pressure (SBP) and weight before and after the NDCPP (P < 0.001). Also, there was significant improvement in carbohydrate (P = 0.015) and protein intake (P = 0.027) after the NDCPP compared to before the study. No significant difference was observed in waist circumference (WC) (P = 0.689), body mass index (P = 0.784), diastolic blood pressure (P = 0.647), and other dietary nutrient intake before and after the NDCPP. Repeated measure ANOVA revealed a significant decrease in FBS (Time effect P = 0.019) and weight (Time effect P = 0.006) after the NDCPP. Also, residing in different cities had a significant effect on FBS (time×city effect P < 0.001), HbA1 C (time×city effect P < 0.001), and SBP (time×city effect P = 0.037) after the NDCPP. The NDCPP resulted in weight loss, improved HbA1 C, and FBS. These findings suggested that NDCPP had a positive effect on controlling T2DM among Iranian population and can be considered as a way to prevent complications of T2DM.
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Affiliation(s)
- Simin Haghravan
- Students Research Committee, Tabriz University ofMedical Sciences, Tabriz, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- PhD in Nutrition(Minor: Economics), Research Department of Food and Nutrition Policyand Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rafraf
- Nutrition Research Center, Faculty of Nutritionand Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
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Socio-Economic Status May Associate Different Risk(s) with Early Childhood Caries (ECC) That Can Cause the Development of Psychomotor Deficiency in Preschool Children Aged 3-6 Years Old: The Results of Preliminary Analysis from a Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179011. [PMID: 34501597 PMCID: PMC8431080 DOI: 10.3390/ijerph18179011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We have recently shown that there is a positive correlation between severe caries and developing psychomotor deficiency in preschool children. To fully re-assess such a relationship, we embarked on a 3-year longitudinal follow-up study of kindergarteners, where we aimed to: (i) confirm whether early childhood caries is causally related to the development of psychomotor deficiency as proposed, and (ii) address any significant role or contribution of socio-economic status associated with caries-psychomotor interactions in the preschooler family cohorts studied, over time. METHODS A longitudinal study was designed where the total sum of 159 kindergarteners aged 3-6 from the central and southern regions of Taiwan were randomly selected and recruited for clinical examination of caries, together with questionnaires for personal, demographic and dietary information, socio-economic status, and the children's psychomotor development scales which were collected and analyzed over time. Student's t test, chi-squared test, correlation coefficients, and multiple linear regression analysis with R2 determinants were employed to assess any attributable differences (of 0~1) between SES vs. psychomotor manifests and caries measured among all variables computed. RESULTS The results of our preliminary analyses show that: (i) there was likely a causal relationship between caries activities and aspects of general development scale via the Chinese Child Development Inventory over time (4.01 ± 3.47 vs. 5.88 ± 2.58, respectively) in the 3-6-year-old preschoolers, and (ii) there was significantly more attributable influence (via higher R-squared values) from SES and psychomotor manifests than that of caries and the Chinese Child Development Inventory counterparts, as detected over time. CONCLUSION Collectively, the resulting analyses support our previous findings and confirm that there is likely a causal relationship between severe caries and psychomotor deficiency in growing preschoolers; the resulting analyses revealed that such causally related interactions may be attributably explainable by a content-reliant association via socio-economic status analyzed in the kindergartener family cohorts studied. Thus, the socio-economic status or its constituents/factors will have a much broader influence not only associated with developing early childhood caries (a biologic trait), but also for psychomotor deficiency (a social trait) in vulnerable children at risk.
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Bai A, Tao J, Tao L, Liu J. Prevalence and risk factors of diabetes among adults aged 45 years or older in China: A national cross-sectional study. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00265. [PMID: 34277988 PMCID: PMC8279593 DOI: 10.1002/edm2.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022]
Abstract
Background Although there is preponderance of literature on disease burden of diabetes in developed countries, limited investigations have been conducted in less developed regions including China. This study aimed to explore the current prevalence and risk factors for diabetes, pre‐diabetes, awareness, treatment and control of diabetes in China. Methods We included 12,458 adults from the China Health and Retirement Longitudinal Study. We estimated prevalence of diabetes and pre‐diabetes in the overall sample and by socio‐demographics. Bivariate associations of diabetes, pre‐diabetes, awareness, control and treatment of diabetes with health and function measures were evaluated by chi‐squared test and multivariate logistic regression analysis. Results We found that the prevalence of diabetes and pre‐diabetes was 13.21% and 25.16%. The prevalence of diabetes increased with advanced age (12.37%, 15.98% and 16.52% among persons who were 45 to 55, 55 to 65 and ≥65 years old, respectively), educational background (14.52%, 15.52% and 15.58% among persons who were illiterate, had primary education and had secondary or above education) and weight (8.18%, 17.05% and 22.54% among persons with a body mass index of 18.5 to 24.9, 25.0 to 29.9 and ≥30.0, respectively). The prevalence of diabetes was higher among urban residents than among rural residents (19.04% vs. 12.85%). We also observed that aged between 55 and 65 years, obesity, history of hypertension and coronary heart disease, and inactivity were significant risk factors of awareness of diabetes. Conclusion Our results indicated that diabetes is high prevalent in adults aged 45 years or above in China. The potentially modifiable risk factors should be further studied to develop interventions and strategies aimed at prevention and treatment of diabetes among middle‐aged and older Chinese adults.
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Affiliation(s)
- Anying Bai
- School of Public Health Peking University Beijing China
| | - Jing Tao
- College of Rehabilitation Medicine Fujian University of Traditional Chinese Medicine Fujian China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology Peking University Third Hospital Beijing China
| | - Jue Liu
- School of Public Health Peking University Beijing China
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Joud H, Mohamed E, Mirza S, Tabbaa H, Tabbaa M, Khan F, Ayoubi N, MacDonald M, Woodard L, Oxner A, Guerra L, Bakour C, Mirza AS. Prevalence and management of diabetes among the uninsured: A multicenter study in Tampa Bay, FL. Diabetes Res Clin Pract 2021; 171:108560. [PMID: 33271229 DOI: 10.1016/j.diabres.2020.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/03/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
AIMS This study describes the prevalence and management of uninsured patients with diabetes in free clinics around the Tampa Bay area. METHODS A retrospective chart review collected data from uninsured patients who visited nine free clinics from January 2016 to December 2017. The data included sociodemographics, chronic disease diagnoses and treatments, and social history. Statistical analysis including chi-square tests and logistic regression were used to describe patients with diabetes. RESULTS With a prevalence of 19.41% among 6815 uninsured patients and a mean HbA1c of 7.9% (63 mmol/mol), patients with diabetes were more likely to be White, women, obese, unemployed, and have hypertension and depression compared to patients without diabetes. There were no significant differences in sociodemographic variables between those with controlled and uncontrolled diabetes. Among the variables studied by logistic regression, unemployment was found to be a significant predictor of poor glycemic control among men. CONCLUSIONS Diabetes is a challenging chronic disease among the uninsured of Tampa Bay due to its prevalence and suboptimal glycemic control. Obesity and unemployment represent significant challenges that increase the burden of diabetes among the uninsured. Free clinics may benefit from additional resources and intervention programs, with future research assessing their effects on care outcomes.
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Affiliation(s)
- Hadi Joud
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
| | - Eslam Mohamed
- Family Medicine, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL 34478, USA
| | - Sabbir Mirza
- William Carey University College of Osteopathic Medicine, 710 William Carey Parkway, Hattiesburg, MS 39401, USA
| | - Hozaifa Tabbaa
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Blvd., Bradenton, FL 34211, USA
| | - Mouaz Tabbaa
- College of Arts and Sciences, University of South Florida, 4202 E. Fowler Avenue, CPR 107, Tampa, FL 33620, USA
| | - Firaas Khan
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Noura Ayoubi
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Madeline MacDonald
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Laurie Woodard
- Department of Family Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Asa Oxner
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Lucy Guerra
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
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Chandrupatla SG, Khalid I, Muthuluri T, Dantala S, Tavares M. Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey. Epidemiol Health 2020; 42:e2020065. [PMID: 32972049 PMCID: PMC7871157 DOI: 10.4178/epih.e2020065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to approximate the prevalence of hyperglycemia in India. METHODS The study was conducted using the Demographic and Health Survey 2015-16 (also known as the National Family Health Survey-4), which surveyed 811,808 individuals using a stratified, multistage, cluster sampling design. This cross-sectional survey recorded socio-demographic and anthropometric data, including blood glucose levels, of adults aged 18 years to 54 years. RESULTS The final analysis included 718,597 individuals, of whom 49.90% (weighted) were males. The overall prevalence of diabetes was 6.65% and that of prediabetes was 5.57%. A positive association was seen with urban residence, geographic region, sex, age, body mass index, socioeconomic status, and hypertension. Approximately two-thirds of individuals with diabetes lived in urban areas, and about half of the urban population was considered overweight/obese. South India showed a higher prevalence of diabetes (prevalence ratio, 2.01; p<0.001) than northern India. CONCLUSIONS Hyperglycemia (diabetes and prediabetes) has a high prevalence in India and is a major public health issue. Diabetes is unevenly distributed based on geographic location and urbanization. Prevention, early detection, and treatment strategies should consider this uneven distribution of diabetes.
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Affiliation(s)
- Siddardha G. Chandrupatla
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Isma Khalid
- Department of Pediatric Dentistry, Boston University, Boston, MA, USA
| | - Tejdeep Muthuluri
- Deptartment of Oral Surgery, SVS Dental College, Mehboobnagar, India
| | | | - Mary Tavares
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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Cao G, Cui Z, Ma Q, Wang C, Xu Y, Sun H, Ma Y. Changes in health inequalities for patients with diabetes among middle-aged and elderly in China from 2011 to 2015. BMC Health Serv Res 2020; 20:719. [PMID: 32758213 PMCID: PMC7405442 DOI: 10.1186/s12913-020-05609-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this paper is to measure income-related health inequality among middle-aged and elderly patients with diabetes in China from 2011 to 2015 and to investigate factors that might be related to this inequality. METHODS The data for this study were obtained from the China Health and Retirement Longitudinal Study that was carried out in 2011, 2013 and 2015. In total, 48,519 Chinese middle-aged and elderly population were included (15,457 in 2011, 16,576 in 2013 and 16,486 in 2015). A principal component analysis was performed to measure asset-based economic status. The concentration index was used to measure income-related inequality in patients with diabetes. Additionally, by used generalized linear model, we decomposed the concentration index to identify factors that explained wealth-related inequality in patients with diabetes. RESULTS The prevalence of self-reported diabetes among middle-aged and elderly Chinese was 5.61, 7.49 and 8.99% in 2011, 2013 and 2015, respectively. The concentration indices and 95% confidence intervals for diabetes were 0.1359 (0.0525-0.0597), 0.1207 (0.0709-0.0789), 0.1021 (0.0855-0.0942) in 2011, 2013, and 2015, respectively, which are indicative of inequality that favors the rich. The decomposition of the concentration index showed that residence (39.38%), BMI (31.16%), education (7.28%), and region (6.09%) had positive contributions to the measured inequality in diabetes in China in 2015. Age (- 29.93%) had a negative contribution to inequality. CONCLUSION The findings confirm a health inequality in diabetes that favor the rich. Furthermore, the inequality declined from 2011 to 2015. We suggest that policy and intervention strategies should be developed to alleviate this health inequality, such as narrow the gap between urban and rural areas by improving the urban-rural medical insurance scheme, implementing strategies to enhance hygiene health education, control obesity rate.
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Affiliation(s)
- Guizhen Cao
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, 199 Ren-ai Rd, SuZhou City, Jiangsu Province 215123 P. R. China
| | - Zhizhen Cui
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, 199 Ren-ai Rd, SuZhou City, Jiangsu Province 215123 P. R. China
| | - Qinghua Ma
- The 3rd People’s Hospital of Xiangcheng District, Suzhou, 215134 P. R. China
| | - Congju Wang
- Centers for Disease Control and Prevention of Suzhou High-tech Zone, Suzhou, 215000 P. R. China
| | - Yong Xu
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, 199 Ren-ai Rd, SuZhou City, Jiangsu Province 215123 P. R. China
| | - Hongpeng Sun
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, 199 Ren-ai Rd, SuZhou City, Jiangsu Province 215123 P. R. China
| | - Yana Ma
- Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, 199 Ren-ai Rd, SuZhou City, Jiangsu Province 215123 P. R. China
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Zhao J, Zhang Y, Wei F, Song J, Cao Z, Chen C, Zhang K, Feng S, Wang Y, Li WD. Triglyceride is an independent predictor of type 2 diabetes among middle-aged and older adults: a prospective study with 8-year follow-ups in two cohorts. J Transl Med 2019; 17:403. [PMID: 31801571 PMCID: PMC6894231 DOI: 10.1186/s12967-019-02156-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Although there is abundant evidence indicating the connection between triglyceride and type 2 diabetes mellitus (T2DM), few reports or cohort studies confirm that high TG concentration may predict the incidence of T2DM independently. Thus, we studied the association between triglyceride (TG) and T2DM in a male-dominated, middle and older aged cohort, Tianjin General Hospital Cohort. And we further verified our results in the China Health and Retirement Longitudinal Study (CHARLS). Methods We conducted an 8-year retrospective cohort study (2009–2017) with 7241 participants who were free from T2DM at baseline. Three groups were constructed based on baseline TG levels (normal, borderline-high, and high). We used a Cox proportional hazards model to evaluate the relationship between TG and T2DM after adjusting for possible risk factors. A Kaplan–Meier survival analysis was performed to compare the incidence of T2DM among subjects in each TG group. We also tested the association between TG and T2DM in the CHARLS cohort. Results In Tianjin General Hospital Cohort, 7241 participants (male 75.8%, female 24.2%) were included, mean age was 61.49 ± 13.85 years at baseline. The cumulative incidence of T2DM in our cohort study was 8.6% (9.2% in men and 6.6% in women). Compared with the normal TG group, the hazard ratios in the borderline and high group were 1.30 (95% CI 1.04–1.62) and 1.54 (95% CI 1.24–1.90). The Kaplan–Meier survival analysis indicated that higher TG levels may predict higher onset of T2DM. These results were verified in the CHARLS cohort, the hazard ratio with T2DM (95% CI) for logTG was 3.94 (2.64–5.87). Conclusions Our findings suggest that the TG level may be an independent risk factor and predictor for T2DM.
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Affiliation(s)
- Jing Zhao
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuan Zhang
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Fengjiang Wei
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jiani Song
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Zhi Cao
- College of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Chen Chen
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Kai Zhang
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Shuzhi Feng
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Yaogang Wang
- College of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| | - Wei-Dong Li
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
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Shukla A, Baghel AS, Vyas M. Diet and lifestyle-related factors associated with Apathyanimittaja Prameha (type 2 diabetes): A cross-sectional survey study. Ayu 2019; 39:199-207. [PMID: 31367141 PMCID: PMC6639821 DOI: 10.4103/ayu.ayu_108_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Lifestyle disorders are the leading cause of death and disability worldwide. Type 2 diabetes is one such disease with high incidence in low- and middle-income countries such as India. Changed lifestyle, lack of exercise, increased consumption of fatty, fast-food items, improper dietary habits and sedentary life are the main contributory factors for this, which are showing upward trend in India. Aims and Objectives The aim of the study is to identify the lifestyle factors, physical activities and psychological factors associated with type 2 diabetes among the patient aged between 20-60 years. Materials and Methods A cross-sectional survey study was conducted on selected 150 patients of type 2 diabetes within 1 year of diagnosis. A survey questionnaire was used to collect the data for fulfilling the aims and objectives of the study. Results and Observations 150 patients of type 2 diabetes were observed on various dietary factors, physical activities and life style factors. Conclusion On the basis of survey psychological factor association with type 2 diabetes and dietary factors, physical activities and psychological factors observed in survey study. The obtained data exposed that intake of heavy, high fatty food, physical inactivity, day sleep and psychological distress as the main lifestyle factors associated with type 2 diabetes.
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Affiliation(s)
- Akhilesh Shukla
- Department of Ayurveda Samhita and Siddhanta, Government Ayurveda College, Bilaspur, Chhattisgarh, India
| | - A S Baghel
- Department of Basic Principles, IPGT and RA, Jamnagar, Gujarat, India
| | - Mahesh Vyas
- Department of Basic Principles, IPGT and RA, Jamnagar, Gujarat, India
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Min D, Cho E. Risk Factors for Underdiagnosis of Diabetes Based on the Korean National Health and Nutrition Examination Survey 2013-2015. Asia Pac J Public Health 2019; 31:404-412. [PMID: 31226885 DOI: 10.1177/1010539519858009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We included 11 298 subjects aged 30 years or older without diagnosis of diabetes by doctors who had undergone A1C screening. The diagnostic criterion for diabetes was A1C ≥6.5% (48 µmol/mol). This cross-sectional study was performed by reflecting weight of the sample in Korean National Health and Nutrition Examination Survey to represent South Korea. Risk factors were age (odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.04-1.08), Medicaid beneficiary (OR = 2.77, 95% CI = 1.25-6.14), presence of family history of diabetes (OR = 1.97, 95% CI = 1.36-2.84), serum triglyceride level (OR = 1.01, 95% CI = 1.01-1.03), serum high-density lipoprotein level (OR = 0.96, 95% CI = 0.95-0.98), currently smoking (OR = 1.85, 95% CI = 1.20-2.85), and the presence of regular checkup (OR = 1.41, 95% CI = 1.01-2.00). To prevent diabetes with a healthy life, it is necessary to establish a diabetes prevention program for vulnerable people and implement health-related policies such as smoking cessation and regular checkups.
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Affiliation(s)
- Deulle Min
- 1 Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Eunhee Cho
- 2 Yonsei University College of Nursing & Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea
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Liu X, Xu W, Cai H, Gao YT, Li H, Ji BT, Shu X, Wang T, Gerszten RE, Zheng W, Xiang YB, Shu XO. Green tea consumption and risk of type 2 diabetes in Chinese adults: the Shanghai Women's Health Study and the Shanghai Men's Health Study. Int J Epidemiol 2018; 47:1887-1896. [PMID: 30169796 PMCID: PMC6280927 DOI: 10.1093/ije/dyy173] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 12/23/2022] Open
Abstract
Background Epidemiological evidence on the association between tea consumption and the risk of type 2 diabetes (T2D) is inconsistent. This study prospectively investigated whether green tea drinking affects the risk of T2D. Methods This study included participants from the Shanghai Women's Health Study (N = 67 058) and the Shanghai Men's Health Study (N = 52 315) without diabetes at study enrolment. Details of tea consumption, including types and amounts, were collected at the baseline and follow-up survey. Incident T2D was identified through follow-up surveys. Plasma level of caffeine metabolite was measured in a nested case-control study involving 592 diabetes case-control pairs. Cox regression analysis, with tea drinking as a time-dependent variable and covariates adjusted for by a propensity score, was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) for T2D risk. Logistic regression analysis was applied to evaluate the association between caffeine metabolites and T2D risk. Results Current green tea drinkers had an increased risk of T2D compared with non-current drinkers [HR = 1.20 (95% CI = 1.14-1.27)], and a dose-response relationship was observed for duration of drinking tea and the amount of tea consumed [P for trend <0.001]. The increased risk associated with green tea drinking was observed in both women and men, across the entire period of follow-up, with HR (95% CI) of 1.08 (0.97-1.19) within 5 years of follow-up, 1.22 (1.12-1.32) during the period of 5-10 years of follow-up and 1.16 (1.03-1.30) after 10 years of follow-up. This association did not vary significantly by body mass index, waist-to-hip circumference ratio or smoking status. Plasma level of caffeine was also associated with increased diabetes risk (P = 0.03), confirming the results based on self-reported tea drinking. Conclusions Green tea drinking was associated with an increased risk of T2D in Chinese adults. The mechanisms underlying the association need to be elucidated.
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Affiliation(s)
- Xiaona Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Wanghong Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Hui Cai
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Jiaotong University Renji Hospital, Shanghai, China
| | - Honglan Li
- Department of Epidemiology, Shanghai Jiaotong University Renji Hospital, Shanghai, China
| | - Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Xiang Shu
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Thomas Wang
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Wei Zheng
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yong-Bing Xiang
- Department of Epidemiology, Shanghai Jiaotong University Renji Hospital, Shanghai, China
| | - Xiao-Ou Shu
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Nagamine Y, Kondo N, Yokobayashi K, Ota A, Miyaguni Y, Sasaki Y, Tani Y, Kondo K. Socioeconomic Disparity in the Prevalence of Objectively Evaluated Diabetes Among Older Japanese Adults: JAGES Cross-Sectional Data in 2010. J Epidemiol 2018; 29:295-301. [PMID: 30449769 PMCID: PMC6614078 DOI: 10.2188/jea.je20170206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Studies on sex-specific socioeconomic gradients in objectively evaluated diabetes among older adults are scarce. Methods We used cross-sectional data of 9,893 adults aged 65 years and older in Aichi Prefecture without long-term care insurance from the Japan Gerontological Evaluation Study (JAGES) in 2010 (Response rate: 66.3%). We collected demographic, socioeconomic (income, years of education, and longest occupation) and behavioral information using a mail-in self-reported survey. Blood samples for the objectively evaluated diabetes and self-reported medical history were collected at annual municipal health checkups. Poisson regression analysis stratified by sex with multiple imputations was conducted to calculate prevalence ratio and 95% confidence interval. Results A clear income gradient in diabetes prevalence was observed among women, from 11.7% in the lowest income quartile (Q1) to 7.8% in the highest (Q4). Among men, the findings were 17.6% in Q1 to 15.1% in Q4. The prevalence ratios for diabetes with incomes Q1 to Q4 were 1.43 (95% confidence interval [CI], 1.07–1.90) for women and 1.16 (95% CI, 0.90–1.50) for men after adjusting for age and other socioeconomic factors. Even after adjusting for marital status, body mass index, other metabolic risk factors, and lifestyle factors, the income-based gradient remained among women. Education and occupation were not significantly associated with diabetes in the study population. Conclusions Only women showed an income-based gradient in diabetes. Monitoring income gradient in diabetes is important in public health actions, even in older populations. Future longitudinal and intervention studies should evaluate the causal link of income to diabetes onset, determine the mechanisms of the potential sex differences in the income/diabetes association, and identify ways to mitigate the income-based inequality.
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Affiliation(s)
- Yuiko Nagamine
- Department of Public Health, Graduate School of Medicine, Chiba University
| | - Naoki Kondo
- Department of Health Education and Health Sociology, School of Public Health, the University of Tokyo
| | | | - Asami Ota
- Division of Health and Nutrition, University of Niigata Prefecture
| | - Yasuhiro Miyaguni
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology
| | - Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU).,Research Fellow of Japan Society for the Promotion of Science
| | - Katsunori Kondo
- Department of Public Health, Graduate School of Medicine, Chiba University.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology.,Center for Well-being and Society, Nihon Fukushi University
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17
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Wu H, Jackson CA, Wild SH, Jian W, Dong J, Gasevic D. Socioeconomic status and self-reported, screen-detected and total diabetes prevalence in Chinese men and women in 2011-2012: a nationwide cross-sectional study. J Glob Health 2018; 8:020501. [PMID: 30140436 PMCID: PMC6076585 DOI: 10.7189/jogh.08.020501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background A rapid epidemiological transition is taking place in China and the association between socioeconomic status (SES) and diabetes prevalence is not clear and may vary by population characteristics and geography within the country. We describe the associations between educational level, annual household living expenditure (AHLE) and diabetes prevalence in a large middle-aged and elderly Chinese population using data from a nationwide cross-sectional study. Methods We used data from the China Health and Retirement Longitudinal Study, which collected information from interviews and blood tests from a nationwide sample of people over 44 years of age in 2011-2012. We used multivariable logistic regression to describe the association between highest levels of education (high school or above compared to illiterate) or AHLE (top vs bottom quartile) and self-reported, screen-detected or total diabetes prevalence. We stratified by sex and adjusted for age, education or AHLE (as appropriate), urban, rural or migrant residence status and geographical area. Results Complete data were available for 10 100 participants of whom 10.5% and 28.9% had the highest and the lowest levels of education respectively. Overall prevalence of self-reported diabetes was 6.0% and of screen-detected diabetes was 9.8%. Higher education level was associated with both self-reported diabetes (odds ratio (OR) = 2.41, 95% confidence interval CI = 1.36-4.46) and total diabetes (OR = 1.53 95%, CI = 1.10-2.15) only in men. AHLE was associated with self-reported diabetes in men (OR = 1.87, 95% CI = 1.26-2.84) and women (OR = 2.31, 95% CI = 1.62-3.34). There was no association between SES and screen-detected diabetes for men or women. Conclusions SES inequalities exist in prevalence of diabetes in China and can be used to inform approaches to prevention. Identification and appropriate intervention for people with undiagnosed diabetes is required for all SES groups.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Weiyan Jian
- School of Public Health, Peking University, Beijing, China
| | - Jianqun Dong
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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Hou J, Sun H, Zhou Y, Zhang Y, Yin W, Xu T, Cheng J, Chen W, Yuan J. Environmental exposure to polycyclic aromatic hydrocarbons, kitchen ventilation, fractional exhaled nitric oxide, and risk of diabetes among Chinese females. INDOOR AIR 2018; 28:383-393. [PMID: 29444361 DOI: 10.1111/ina.12453] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Diabetes is related to exposure to polycyclic aromatic hydrocarbons (PAHs), inflammation in the body, and housing characters. However, associations of urinary monohydroxy-PAHs (OH-PAHs) or fractional exhaled nitric oxide (FeNO) with diabetes risk in relation to housing characters are unclear. In this study, 2645 individuals were drawn from the baseline survey of the Wuhan-Zhuhai Cohort Study. Associations of diabetes with urinary OH-PAHs or FeNO among cooking participants were estimated using logistic regression models. Among women with self-cooking meals, urinary OH-PAH levels were positively associated with diabetes risk (P < .05); the cooking women with high FeNO (≥25 ppb) had a 59% increase in the risk of diabetes (OR: 1.59, 95% CI: 1.06, 2.38), compared with those with low FeNO (<25 ppb). The cooking women with use of kitchen exhaust fans/hoods had a 52% decrease in the risk of diabetes (OR: 0.48, 95% CI: 0.27, 0.84), compared with those with nonuse of kitchen exhaust fans/hoods. The results indicated that the cooking women had an elevated risk of diabetes, which may be partly explained by an increase in the PAH body burden and higher inflammatory responses. Use of kitchen exhaust fan/hood can be associated with a lower risk of diabetes.
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Affiliation(s)
- J Hou
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - H Sun
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Huizhen Sun, Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Y Zhou
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Zhang
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - W Yin
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - T Xu
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Cheng
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - W Chen
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Yuan
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Chandra Babu G, Shantharajah SP. Optimal body mass index cutoff point for cardiovascular disease and high blood pressure. Neural Comput Appl 2018. [DOI: 10.1007/s00521-018-3484-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Xu Z, Yu D, Yin X, Zheng F, Li H. Socioeconomic status is associated with global diabetes prevalence. Oncotarget 2018; 8:44434-44439. [PMID: 28574844 PMCID: PMC5546491 DOI: 10.18632/oncotarget.17902] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/27/2017] [Indexed: 12/04/2022] Open
Abstract
The incidence of diabetes is increasing globally. We investigated the relationship between diabetes prevalence and patient socioeconomic status across multiple countries. We searched PubMed to identify population-based surveys reporting diabetes prevalence between 1990 and May 2016. Search results were filtered, and Human Development Index (HDI) values from the United Nations Development Programme were used to assess socioeconomic status for a given nation. Our analysis included 45 national surveys from 32 countries. Diabetes prevalence was positively correlated with national HDI (r = 0.421 P = 0.041) in developing countries, and negatively correlated with HDI (r = −0.442 P = 0.045) in developed countries. Diabetes prevalence trends were the same in women and men, although men were associated with increased diabetes risk in developed countries (r = 0.459 P = 0.048). Thus, diabetes prevalence rises with increasing HDI in developing countries, and this is reversed in developed countries. Ours is the first study to investigate the relationship between diabetes and socioeconomic status at global level using HDI values. These results will aid in evaluating global diabetes prevalence and risk with respect to patient socioeconomic status, and will be useful in the development of policies that help reduce disease incidence.
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Affiliation(s)
- Zhiye Xu
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang Province, China
| | - Dan Yu
- Department of Endocrinology, Zhejiang Hospital, 310013, Hangzhou, Zhejiang Province, China
| | - Xueyao Yin
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang Province, China
| | - Fenping Zheng
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang Province, China
| | - Hong Li
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang Province, China
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Wang Z, Li X, Chen M. Socioeconomic Factors and Inequality in the Prevalence and Treatment of Diabetes among Middle-Aged and Elderly Adults in China. J Diabetes Res 2018; 2018:1471808. [PMID: 30687763 PMCID: PMC6327275 DOI: 10.1155/2018/1471808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/28/2018] [Accepted: 11/14/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In China, the prevalence of diabetes has increased significantly over recent decades, owing to the county's rapidly aging population. Although many studies have examined the prevalence of diabetes worldwide, there has been little analysis of the inequalities in its prevalence and treatment among middle-aged and elderly people. OBJECTIVES This study evaluates influence factors and inequality in respect to the prevalence of diabetes and medication treatment among middle-aged and elderly Chinese adults. METHODS Data were obtained from the China Health and Retirement Longitudinal Study, a nationally representative household survey of middle-aged and elderly people (i.e., 45 years of age or older). Logistic regression models and the concentration index were used to estimate socioeconomic factors and inequalities in diabetes prevalence and treatment. RESULTS The prevalence of self-reported diabetes among middle-aged and elderly Chinese adults was 8.4%; this figure was significantly higher in urban areas than in rural areas. Concentrations of prevalence were observed among the poor in urban areas and among the rich in rural areas. Overall, the incidence of receiving antidiabetic medication among diabetes patients was 64.3%; this was significantly higher for individuals in urban areas than those in rural areas, suggesting that awareness of diabetes treatment in urban areas is better than that in rural areas. A disproportionate concentration of incidence of receiving antidiabetic medication was observed among the rich in both urban and rural areas. Socioeconomic factors significantly affected the prevalence of diabetes and the likelihood of receiving medication and are major contributors to inequality. CONCLUSION In China, policies and strategies regarding diabetes prevention and control should further focus on associated socioeconomic factors and major contributors to reduce diabetes prevalence, improve diabetes treatment and management, and alleviate current inequality in the prevalence and treatment of diabetes among middle-aged and elderly adults.
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Affiliation(s)
- Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, 211166 Nanjing, China
- Creative Health Policy Research Group, Nanjing Medical University, 211166 Nanjing, China
| | - Xiangjun Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 210023 Nanjing, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, 211166 Nanjing, China
- Creative Health Policy Research Group, Nanjing Medical University, 211166 Nanjing, China
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Varanka-Ruuska T, Rautio N, Lehtiniemi H, Miettunen J, Keinänen-Kiukaanniemi S, Sebert S, Ala-Mursula L. The association of unemployment with glucose metabolism: a systematic review and meta-analysis. Int J Public Health 2017; 63:435-446. [PMID: 29170882 DOI: 10.1007/s00038-017-1040-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/12/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Unemployment has been linked with poor health. We hypothesized that being unemployed is associated with disorders of glucose metabolism and performed a systematic review and meta-analysis of the literature to ascertain the relationship. METHODS We searched the databases of Scopus, Medline Ovid and Web of Science for population-based original studies for past 20 years. Random effects meta-analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for prediabetes and type 2 diabetes among the unemployed as compared to those employed, separately for men and women when possible. RESULTS Out of 981 articles found, 12 articles were included in the systematic review and eight articles in the meta-analyses. Unemployment was associated with 1.6-fold odds for prediabetes (OR 1.58; 95% CI 1.07-2.35), and 1.7-fold odds for type 2 diabetes (OR 1.72; 95% CI 1.14-2.58) in the total sample. The corresponding associations for type 2 diabetes were also found stratified for men (OR 1.53; 95% CI 1.47-1.60) and women (OR 1.60; 95% CI 1.33-1.92). CONCLUSIONS Unemployment is associated with prediabetes and type 2 diabetes, global concerns of public health with potential for prevention.
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Affiliation(s)
- Tuulia Varanka-Ruuska
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland. .,Kallio Primary Health Care Unit, Kirkkotie 4, 84100, Ylivieska, Finland.
| | - Nina Rautio
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, P.O. Box 20, 90029 OYS, Oulu, Finland
| | - Heli Lehtiniemi
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, P.O. Box 20, 90029 OYS, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Health Center of Oulu, P.O. Box 27, 90015, Oulu, Finland
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Department of Genomics of Complex Diseases, Imperial College London, South Kensington Campus, London, SW7, UK
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
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Xiao M, O'Neill C. Detection and Management of Diabetes in England: Results from the Health Survey for England. Diabetes Ther 2017; 8:1163-1174. [PMID: 28948483 PMCID: PMC5630556 DOI: 10.1007/s13300-017-0300-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. METHODS Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups. RESULTS In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. CONCLUSION In the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.
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Affiliation(s)
- Mimi Xiao
- School of Business and Economics, NUI Galway, Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, UK.
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Wu H, Meng X, Wild SH, Gasevic D, Jackson CA. Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review. J Glob Health 2017; 7:011103. [PMID: 28702177 PMCID: PMC5481892 DOI: 10.7189/jogh.07.011103] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan. METHODS We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis. RESULTS Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age. CONCLUSIONS This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Xiangrui Meng
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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Rahman MM, Akter S, Jung J, Rahman MS, Sultana P. Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh. Diabetes Res Clin Pract 2017; 126:43-53. [PMID: 28192721 DOI: 10.1016/j.diabres.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes. METHODS We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes. FINDINGS Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2-4.3) to 12.1% (9.1-15.4) in men, and from 2.5% (1.8-3.5) to 13.4% (9.7-17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6-36.3) for men and 33.5% (19.9-50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6-13.7) to 20.4% (18.4-22.4%) in 2015 in men, and from 14.0% (10.3-19.0) to 21.3% (19.0-23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5kg/m2 or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23kg/m2 for overall population, 22kg/m2 for men, and 23kg/m2 for women. INTERPRETATION Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22.5kg/m2 or more is risk factors for developing diabetes and hypertension. Screening for diabetes may be considered for all Bangladeshi adults with a BMI of ⩾23kg/m2.
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Affiliation(s)
- Md Mizanur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan; Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh.
| | - Shamima Akter
- Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jenny Jung
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Md Shafiur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Finger B, Brase J, He J, Gibson WJ, Wirtz K, Flynn BC. Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac Surgical Procedures. Ann Thorac Surg 2017; 103:145-151. [DOI: 10.1016/j.athoracsur.2016.05.092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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Ebrahimi H, Emamian MH, Hashemi H, Fotouhi A. High Incidence of Diabetes Mellitus Among a Middle-Aged Population in Iran: A Longitudinal Study. Can J Diabetes 2016; 40:570-575. [PMID: 27476052 DOI: 10.1016/j.jcjd.2016.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/12/2016] [Accepted: 05/16/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVES There are few data concerning the incidence rates of diabetes in Iran. This study aimed to determine the incidence of diabetes and its risk factors in a middle-aged population in Iran. METHODS All of the people who participated in the first phase of the Shahroud eye cohort study were invited to the study in 2014; after signing informed consent forms, a total of 4737 people 45 to 69 years of age were enrolled in the second phase of the study (participation rate: 91.3%). The 5-year incidence rate of diabetes was determined by age and sex, and we used the binomial logistic regression model to calculate the risk ratio. RESULTS The prevalence of diabetes in the second phase was 20.19% in men, 26.45% in women and 23.89% in the total group. The 5-year incidence of diabetes was 11.19% in men, 15.55% in women and 13.73% in both sexes. With increases in age, the incidence of diabetes rose in both sexes. Age (risk ratio [RR]: 1.02; CI 95%: 1.01 to 1.03) hypertension (RR: 1.41; CI 95%: 1.15 to 1.74), being overweight (RR: 2.17; CI 95%: 1.64 to 2.88) and obesity (RR: 3.4; CI 95%: 2.53 to 4.41) were associated with increased risks for the incidence of diabetes. CONCLUSIONS This study is 1 of the few studies in Iran that has reported the incidence of diabetes. Because the incidence of diabetes was high in the studied population, it is necessary for the health system to design and implement emergency intervention to prevent further spread of diabetes and its complications.
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Affiliation(s)
- Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hassan Emamian
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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28
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Tao X, Li J, Zhu X, Zhao B, Sun J, Ji L, Hu D, Pan C, Huang Y, Jiang S, Feng Q, Jiang C. Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus. Cardiovasc Diabetol 2016; 15:61. [PMID: 27048217 PMCID: PMC4822246 DOI: 10.1186/s12933-016-0376-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/25/2016] [Indexed: 01/19/2023] Open
Abstract
Background Low socioeconomic status (SES) is associated with adverse cardiovascular risk factor patterns and poor outcomes in patients with diabetes. The aim of this study was to determine whether SES is associated with the control of blood glucose, blood pressure, blood cholesterol (3Bs), and diabetic complications in Chinese adults with type 2 diabetes. Methods Data regarding patients’ demographics, social economics, diabetes complications, and cardiovascular risk profiles were analyzed for 25,454 patients. The outcomes of interest were the proportions of patients with HbA1c <7.0 %, blood pressure <140/80 mmHg, total serum cholesterol <4.5 mmol/L, and diabetes complications. Multivariable logistic regression was used for analysis. Results Of the 25,454 patients, the least educated patients (1695, 6.7 %) had the highest chances of developing cardiovascular diseases (p = 0.048), cerebrovascular diseases (p < 0.001), and retinopathy (p < 0.001). The patients with lowest household income (10,039, 40.8 %) had the highest prevalence of retinopathy (p < 0.001) and neuropathy (p < 0.001). The most educated patients were more likely than the least educated patients to achieve HbA1c <7.0 % [adjusted odds ratio (OR) 1.38; 95 % confidence interval (95 % CI) 1.22–1.56] and 3B goals (adjusted OR 1.30; 95 % CI 1.11–1.53). The patients with highest household income were more likely to achieve BP < 140/80 mmHg (adjusted OR 1.16; 95 % CI 1.07–1.27), but less likely to reach HbA1c < 7.0 % (adjusted OR 0.90; 95 % CI 0.83–0.98) than those lowest income patients. Conclusions Low SES was associated with poor metabolic control and more diabetes complications in adult patients in China. Individual diabetes management based on the SES of patients is encouraged. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0376-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoming Tao
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China
| | - Jihu Li
- MSD China Holding Co., Ltd., Shanghai, China
| | - Xiaolin Zhu
- MSD China Holding Co., Ltd., Shanghai, China
| | - Bin Zhao
- MSD China Holding Co., Ltd., Shanghai, China
| | - Jiao Sun
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Changyu Pan
- Department of Endocrinology, The Chinese PLA General Hospital, Beijing, China
| | - Yuxin Huang
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China
| | - Suyuan Jiang
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China
| | - Qiang Feng
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China
| | - Cuiping Jiang
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, 221 yananxi road, Shanghai, 200040, China
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Chowdhury MAB, Uddin MJ, Khan HMR, Haque MR. Type 2 diabetes and its correlates among adults in Bangladesh: a population based study. BMC Public Health 2015; 15:1070. [PMID: 26483053 PMCID: PMC4610042 DOI: 10.1186/s12889-015-2413-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/12/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Type 2 diabetes is one of the most prevalent non-communicable diseases in Bangladesh. However, the correlates of type 2 diabetes among adults in Bangladesh remain unknown. We aimed to investigate the correlates of type 2 diabetes among the adults in Bangladesh. METHODS We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. A random sample of 7,543 (3,823 women and 3,720 men) adults of age 35 years and older from both urban and rural areas, who participated in the survey was included. Diabetes was defined as having a fasting plasma blood glucose level of ≥ 7 mm/L or taking diabetes medication during the survey. Hypothesized factors, e.g., age, sex, education, place of residence, social status, body mass index, and hypertension were considered in the analyses. Multivariable logistic regression models were used to identify the important correlates of type 2 diabetes. RESULTS Among the respondents, the overall prevalence of diabetes was 11 %, and the prevalence was slightly higher in women (11.2 %) than men (10.6 %). Respondents with the age group of 55-59 years had higher odds of having diabetes (odds ratios (OR) = 2.37, 95 % confidence interval (CI): 1.76-3.21) than the age group of 35-39 years. Moreover, respondents who had higher educational attainment (OR = 1.67, 95 % CI: 1.18-2.36) and higher social status (OR = 2.01, 95 % CI: 1.50-2.70) had higher odds of having diabetes than the respondents with no education and lower social status, respectively. We also found socioeconomic status, place of residence (rural or urban), regions of residence (different divisions), overweight and obesity, and hypertension as significant correlates of type 2 diabetes in Bangladesh. CONCLUSIONS Our study shows that older age, higher socioeconomic status, higher educational attainment, hypertension, and obesity were found to be significant correlates of type 2 diabetes. Need-based policy program strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations.
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Affiliation(s)
- Muhammad Abdul Baker Chowdhury
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
| | - Hafiz M R Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
| | - Md Rabiul Haque
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
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Zhu S, Hu J, McCoy TP, Li G, Zhu J, Lei M, Yuan J, Peng J, Kong L. Socioeconomic Status and the Prevalence of Type 2 Diabetes Among Adults in Northwest China. DIABETES EDUCATOR 2015; 41:599-608. [PMID: 26246592 DOI: 10.1177/0145721715598382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of the study was to investigate (1) the associations of socioeconomic status, lifestyle risk factors, and the prevalence of newly diagnosed type 2 diabetes and (2) the mediating effects of lifestyle risk factors on the association of socioeconomic status and the prevalence of newly diagnosed type 2 diabetes among Chinese adults in northwest China. METHODS Based on a correlational design and random multistage sampling in communities (N = 3243), data were collected through face-to-face interviews and anthropometric measurements. Education, occupation, and income were considered indicators of socioeconomic status. RESULTS Approximately 7.5% persons interviewed had newly diagnosed type 2 diabetes. Chi-square analyses showed that higher socioeconomic indicators (higher income, nonmanual occupation) were associated with increased risk. Lifestyle risk factors, including alcohol use, unhealthy diet, and higher body mass index, were significantly positively associated with type 2 diabetes. Adjusting for demographic characteristics, hierarchical logistic regression analyses showed that unhealthy diet and high body mass index were significantly associated with type 2 diabetes. CONCLUSIONS Higher incomes and nonmanual occupations were related to a greater prevalence of type 2 diabetes, and high body mass index mediated these associations. These findings suggest that interventions for type 2 diabetes in China should be targeted at populations with high socioeconomic status and nonmanual occupations to reduce lifestyle risk factors and prevent diabetes.
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Affiliation(s)
- Shuzhen Zhu
- School of Nursing, Hubei University of Medicine, Shiyan City, Hubei Province, China (Ms S. Zhu)
| | - Jie Hu
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA (Dr Hu, Dr McCoy)
| | - Thomas P McCoy
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA (Dr Hu, Dr McCoy)
| | - Guangwu Li
- School of Biomedical Engineering, Hubei University of Medicine, Hubei Province, China (Mr Li)
| | - Jianyong Zhu
- Department of Diabetes, Affiliated People's Hospital of Hubei University of Medicine, Shiyan City, Hubei Province, China (Mr J. Zhu, Ms Peng)
| | - Meirong Lei
- School of Nursing, Hubei University of Medicine, Shiyan City, Hubei Province, China (Ms S. Zhu),School of Nursing, Hubei University of Medicine, Hubei Province, China (Ms Lei, Mr Yuan)
| | - Jie Yuan
- School of Nursing, Hubei University of Medicine, Hubei Province, China (Ms Lei, Mr Yuan)
| | - Jingxia Peng
- Department of Diabetes, Affiliated People's Hospital of Hubei University of Medicine, Shiyan City, Hubei Province, China (Mr J. Zhu, Ms Peng)
| | - Linglin Kong
- School of Nursing, Hubei University of Science and Technology, Hubei Province, China (Ms Kong)
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Abstract
The prevalence of diabetes in China has increased substantially over recent decades, with more than 100 million people estimated to be affected by the disease presently. During this period there has been an increase in the rates of obesity and a reduction in physical activity. Many of the changes in lifestyle and diet are a result of increased economic development and urbanisation. In addition to an increasingly westernised diet, the traditional Chinese diet also plays a part, with the quantity and quality of rice intake linked to the risk of type 2 diabetes. Familial factors including inherited genetic variants are important, although differences in the genetic architecture suggest a different combination of genetic variants could be most relevant in Chinese when compared with Europeans. Recent advances have also emphasised the role of early life factors in the epidemic of diabetes and non-communicable diseases: maternal undernutrition, maternal obesity, and gestational diabetes are all linked to increased risk of diabetes in offspring. A mismatch between developmentally programmed biology and the modern environment is relevant for countries like China where there has been rapid economic transformation. Multisectoral efforts to address the risks will be needed at different stages throughout the lifecourse to reduce the burden of diabetes.
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Affiliation(s)
- Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, and The Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
| | - Xu Lin
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate University of the Chinese Academy of Sciences, Shanghai, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Okoduwa SIR, Umar IA, Ibrahim S, Bello F, Ndidi US. Socio-economic status of patients with type 2 diabetes and hypertension attending the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. Glob J Health Sci 2014; 7:280-7. [PMID: 25560354 PMCID: PMC4796455 DOI: 10.5539/gjhs.v7n1p280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/08/2014] [Indexed: 12/14/2022] Open
Abstract
Hypertension (HTN) and Type 2 diabetes (T2D) are lifestyle interrelated diseases of global significance. Interestingly, the prevalence of these diseases in Africa and indeed Nigeria seems to be on the increase. This study, therefore, investigated the socioeconomic status (based on income, education and occupational activity) of 400 subjects (52% female and 48% male) aged 20 years and above who were sampled randomly among the newly diagnosed HTN and/or T2D cases at the Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. A semi-structured questionnaire was used to collect information from the subjects. From the result obtained, most of the respondents who live in towns or city suffer from either HTN or T2D while more town dwellers (28%) suffer from a combination of both diseases. It was also discovered that most respondents who suffer from HTN and from a combination of HTN and T2D belong to the old generation (60-79 years). There is higher prevalence rate of diabetes among the respondents who had no formal education or attended only basic Arabic schools. Most respondents who earn good income (NGN50,000-NGN100,000 and above NGN100,000) suffer HTN, T2D and a combination of both diseases. Those engaged in heavy occupational activities had the lowest prevalence of the disease compared with those of light or moderate occupational activities. These data will be found useful in planning intervention healthcare preventive programs especially on public enlightenment workshops and seminars to educate the populace on the importance of lifestyle modification, healthy diet and regular exercises.
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Costanian C, Bennett K, Hwalla N, Assaad S, Sibai AM. Prevalence, correlates and management of type 2 diabetes mellitus in Lebanon: findings from a national population-based study. Diabetes Res Clin Pract 2014; 105:408-15. [PMID: 25005850 DOI: 10.1016/j.diabres.2014.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 05/05/2014] [Accepted: 06/15/2014] [Indexed: 12/19/2022]
Abstract
AIMS This study aims to examine the prevalence, associated risk factors and complications of diabetes, as well management and preventive care in Lebanon, a small, middle-income country of the Mediterranean region. METHODS Using a comprehensive multi-dimensional questionnaire, a cross-sectional national survey of 2195 Lebanese adults aged ≥25 years was conducted based on the WHO STEPwise guidelines. The outcome variable, diabetes, was self-reported. Measures for diabetes management included frequency of blood glucose testing and regular eye and foot exams. Macrovascular and microvascular complications were also recorded. RESULTS The prevalence of type 2 diabetes was 8.5% (95%CI=7.3-9.7). Factors associated with an increased risk of having diabetes were: being divorced or widowed (OR=2.56; 95%CI=1.07-5.42) compared to single, being obese (OR=1.50, 95%CI=1.00-2.57), and having a family history of diabetes (OR=3.40;95%CI=2.48-5.19). Vigorous physical activity significantly decreased the odds of diabetes (OR=0.42; 95%CI=0.24-0.72). Diabetes management and self-care goals were as follows: 82% were not measuring their blood sugar via dextro on a daily basis, 64.2% did not have a foot exam within the past year, and 52.4% did not obtain the recommended yearly eye exam. The most common complications included heart disease (27.8%) and retinopathy (16.6%). CONCLUSIONS Prevalence of diabetes in Lebanon was comparable to that found in the West, yet remained lower than estimates in other resource-rich neighboring countries. Adherence to management and self-care measures was sub-optimal resulting in high complication rates. Contextual factors play a role in increasing diabetes risk. Population-based interventions to enhance and promote self-management behaviors are essential to improve complication rates.
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Affiliation(s)
- Christy Costanian
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre of Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Nahla Hwalla
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon; Member of the Public Health and Nutrition (PHAN) Research Group at the American University of Beirut, Lebanon
| | - Shafika Assaad
- Lebanese University, Faculty of Sciences, Beirut, Lebanon
| | - Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Member of the Public Health and Nutrition (PHAN) Research Group at the American University of Beirut, Lebanon.
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Hod T, Goldfarb-Rumyantzev AS. The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome. Ren Fail 2014; 36:1193-9. [PMID: 24988495 DOI: 10.3109/0886022x.2014.934179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research focused on identifying vulnerable populations and revealing specific risk factors for barriers along the pathway from ESRD to kidney transplantation has been mostly descriptive and the causes of existing disparities remain unclear. However, several socio-economic factors that are associated with the access to and the outcome of the kidney transplantation have been identified. SUMMARY While the presence of racial, gender, and geographic disparities is noted, we were interested mostly to describe potential socio-economic factors associated with and possibly responsible for the presence of such disparities. In this review we focused on five factors: education level, employment status, income, presence of substance addiction or abuse, and marital status. We describe the new method to quantify patients' socio-economic status and identify the group of high risk in terms of the transplant outcome, easily calculated social adaptability index, previously associated with clinical outcome in several patient populations including those with kidney transplant. At the end, based on literature analyzed we offer potential interventions that potentially can be used in order to reduce the degree of disparities. CONCLUSION Based on review of literature socio-economic factors are associated with and possibly responsible for healthcare disparities. Social adaptability index allows quantifying the degree of socio-economic status and identifying the group of high risk for inferior transplant outcome.
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Affiliation(s)
- Tammy Hod
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston , MA
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Elgart JF, Caporale JE, Asteazarán S, De La Fuente JL, Camilluci C, Brown JB, González CD, Gagliardino JJ. Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Res Clin Pract 2014; 104:241-7. [PMID: 24629409 DOI: 10.1016/j.diabres.2014.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/20/2013] [Accepted: 02/13/2014] [Indexed: 01/18/2023]
Abstract
AIM To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender. METHODS For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%). Data were obtained by telephone interviews and supplemented with data from the institution's records. Group comparisons were performed with parametric or non-parametric tests as appropriate. We used ordinary least squares to regress household income and the difference between income and household expenses on diabetes status, age, sex, education and body mass index. RESULTS Persons with T2DM, particularly those with complications, reported fewer years of general education (13.6±4.2 years vs. 12.2±4.4 years), a lower percentage of full time jobs (43.0% vs. 26.9%), lower salaries and monthly household income among those with full-time jobs (> 5000 ARG$: 52.6% vs. 24.5%), and a higher propensity to spend more money than they earned (expenditure/income ratio≥1: 10.2% vs. 16.0%). The percentage of unmarried people was also higher among people with type 2 diabetes (7.0% vs. 10.9%). CONCLUSION T2DM and the development of its complications are each positively associated with lower SES and greater economic distress in Argentina.
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Affiliation(s)
- Jorge F Elgart
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina.
| | - Joaquín E Caporale
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Santiago Asteazarán
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | | | | | - Jonathan B Brown
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Claudio D González
- Department of Pharmacology, University of Buenos Aires School of Medicine, Argentina
| | - Juan J Gagliardino
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
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Akter S, Rahman MM, Abe SK, Sultana P. Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey. Bull World Health Organ 2014; 92:204-13, 213A. [PMID: 24700980 DOI: 10.2471/blt.13.128371] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/17/2013] [Accepted: 11/19/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors. METHODS Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities. FINDINGS The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence. CONCLUSION Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.
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Affiliation(s)
- Shamima Akter
- Department of Epidemiology and Prevention, Clinical Research Center, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo 162-8655, Japan
| | - M Mizanur Rahman
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Aliarzadeh B, Greiver M, Moineddin R, Meaney C, White D, Moazzam A, Moore KM, Belanger P. Association between socio-economic status and hemoglobin A1c levels in a Canadian primary care adult population without diabetes. BMC FAMILY PRACTICE 2014; 15:7. [PMID: 24410794 PMCID: PMC3890502 DOI: 10.1186/1471-2296-15-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 01/03/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes. METHODS This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011 and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. RESULTS The difference in mean Hgb A1c between highest and lowest income quintiles was -0.04% (p = 0.005, 95% CI -0.07% to -0.01%), and between least deprived and most deprived was -0.05% (p = 0.003, 95% CI -0.09% to -0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI -0.06% to 0.01%) for social deprivation. After adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models. CONCLUSIONS We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support tools that inform the use of Hgb A1c for diabetes screening.
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Affiliation(s)
- Babak Aliarzadeh
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
| | - David White
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1, Canada
| | - Ambreen Moazzam
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto M5G 1 V7, ON, Canada
- North York General Hospital, 4001 Leslie St, Toronto, ON M2K 1E1, Canada
| | - Kieran M Moore
- Public Health Informatics Group, Kingston, Frontenac, Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON K7M 1 V5, Canada
- Department of Emergency Medicine, Queen’s University, Kingston, ON K7L 3 N6, Canada
| | - Paul Belanger
- Public Health Informatics Group, Kingston, Frontenac, Lennox & Addington Public Health, 221 Portsmouth Avenue, Kingston, ON K7M 1 V5, Canada
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