1
|
Ng TKS, Wee HN, Ching J, Kovalik JP, Chan AW, Matchar DB. Plasma Acylcarnitines as Metabolic Signatures of Declining Health-Related Quality of Life Measure in Community-Dwelling Older Adults: A Combined Cross-sectional and Longitudinal Pilot Study. J Gerontol A Biol Sci Med Sci 2024; 79:glac114. [PMID: 35605263 DOI: 10.1093/gerona/glac114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) measures are predictors of adverse health outcomes in older adults. Studies have demonstrated cross-sectional associations between HRQoL measures and blood-based biochemical markers. Acylcarnitines (ACs) are a class of metabolites generated in the mitochondria and are predictive of multiple geriatric syndromes. Changes in ACs reflect alterations in central carbon metabolic pathways. However, the prospective relationship between plasma ACs and declining HRQoL has not been examined. This study aimed to investigate both cross-sectional and longitudinal associations of baseline ACs with baseline and declining EuroQol-5 Dimension/EuroQol Visual Analogue Scale (EQ-5D/EQ-VAS) in community-dwelling older adults. METHODS One hundred and twenty community-dwelling older adults with EQ-5D/EQ-VAS measurements at baseline and follow-up were included. We quantified ACs at baseline using targeted plasma metabolomics profiling. Multivariate regressions were performed to examine cross-sectional and longitudinal associations between the measures. RESULTS Cross-sectionally, ACs showed no significant associations with either EQ-5D index or EQ-VAS scores. Longitudinally, multiple baseline short-chain ACs were significantly and inversely associated with declining EQ-5D index score, explaining up to 8.5% of variance in the decline. CONCLUSIONS Within a cohort of community-dwelling older adults who had high HRQoL at baseline, we showed that higher levels of short-chain ACs are longitudinally associated with declining HRQoL. These findings reveal a novel association between central carbon metabolic pathways and declining HRQoL. Notably, dysregulation in mitochondrial central carbon metabolism could be detected prior to clinically important decline in HRQoL, providing the first evidence of objective biomarkers as novel predictors to monitor HRQoL in nonpharmacological interventions and epidemiology.
Collapse
Affiliation(s)
- Ted Kheng Siang Ng
- Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Hai Ning Wee
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - Angelique W Chan
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
- Department of Sociology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
- Center for Aging, Research and Education, Duke-National University of Singapore Medical School, Singapore
| | - David Bruce Matchar
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
- Center for Aging, Research and Education, Duke-National University of Singapore Medical School, Singapore
- Department of Medicine (General Internal Medicine), Duke University School of Medicine, USA
| |
Collapse
|
2
|
Brückner RM, Schönenberg A, Wientzek R, Schreiber M, Prell T. Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe. J Diabetes 2024. [PMID: 38168898 DOI: 10.1111/1753-0407.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated. METHODS We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure. RESULTS We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2 = 22.097, df = 1, p < .05). CONCLUSIONS As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.
Collapse
Affiliation(s)
| | | | - Rebecca Wientzek
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Mandy Schreiber
- Department of Internal Medicine II, Halle University Hospital, Halle, Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| |
Collapse
|
3
|
Parra-Mujica F, Roope LS, Abdul-Aziz A, Mustapha F, Ng CW, Rampal S, Lim LL, Dakin H, Clarke P. Health poverty among people with type 2 diabetes mellitus (T2DM) in Malaysia. Soc Sci Med 2024; 340:116426. [PMID: 38016309 DOI: 10.1016/j.socscimed.2023.116426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40-75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.
Collapse
Affiliation(s)
- Fiorella Parra-Mujica
- Erasmus School of Health Policy and Management (ESHPM), Erasmus, University Rotterdam, the Netherlands; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Erasmus Center for Health Economics Rotterdam (EsCHER), the Netherlands.
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alia Abdul-Aziz
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Feisul Mustapha
- Non-communicable Disease Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Chiu Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen Dakin
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
4
|
Kim MJ, Hur HJ, Jang DJ, Kim MS, Park S, Yang HJ. Inverse association of a traditional Korean diet composed of a multigrain rice-containing meal with fruits and nuts with metabolic syndrome risk: The KoGES. Front Nutr 2022; 9:1051637. [PMID: 36438748 PMCID: PMC9684706 DOI: 10.3389/fnut.2022.1051637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Hansik, a traditional Korean diet, may have a beneficial impact on metabolic syndrome (MetS) risk as dietary westernization increases its prevalence. We examined the hypothesis that adherence to the hansik diet may be inversely associated with the risk of MetS and its components and sought to understand the gender differences in 58,701 men and women aged over 40. Materials and methods Hansik was defined using 14 components from which the Korean dietary pattern index (Kdiet-index) was generated by summing their scores. Low-hansik intake was defined as the Kdiet-index with <8. MetS was categorized based on the 2005 revised NCEP-ATP III criteria modified for Asians. Results The Kdiet-index score was negatively associated with the dietary inflammation index and showed that the high intake of a meal with multigrain rice, fruits, and their products, and nuts, and low intake of fried foods were inversely associated with MetS by 0.707, 0.864, 0.769, and 0.918 times, respectively, after adjusting for covariates. More women and participants with more educated and lower income belonged to the high-hansik group, and participants with high self-rated health scores consumed more hansik. All participants on a high-hansik diet were associated with a 0.87 time lower risk of MetS. Specifically, the association between hansik intake and MetS risk was not significant among men following stratification by gender. Body composition, including the body mass index, waist circumference, and fat mass, was inversely associated with hansik intake, while the skeletal muscle mass index was positively associated with the hansik intake in each gender and all participants. In all the participants in the high-hansik group, no significant changes were seen in the serum glucose and HDL concentration. However, a high-hansik intake showed lower blood pressure and serum LDL and triglyceride concentrations only in men and a higher glomerular filtration rate in both genders. Conclusions Hansik intake might improve MetS risk, with its primary beneficial effects on body composition, dyslipidemia, and blood pressure gender-dependently.
Collapse
Affiliation(s)
- Min Jung Kim
- Food Functionality Research Division, Korea Food Research Institute, Seongnam-si, South Korea
| | - Haeng Jeon Hur
- Food Functionality Research Division, Korea Food Research Institute, Seongnam-si, South Korea
| | - Dai Ja Jang
- Food Functionality Research Division, Korea Food Research Institute, Seongnam-si, South Korea
| | - Myung-Sunny Kim
- Food Functionality Research Division, Korea Food Research Institute, Seongnam-si, South Korea
- Department of Food Biotechnology, University of Science and Technology, Wanju, South Korea
| | - Sunmin Park
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan-si, South Korea
- R&D, Yejunbio, Asan-si, South Korea
- Sunmin Park
| | - Hye Jeong Yang
- Food Functionality Research Division, Korea Food Research Institute, Seongnam-si, South Korea
- *Correspondence: Hye Jeong Yang
| |
Collapse
|
5
|
Blythe R, White N, Kularatna S, McPhail S, Barnett A. A Bayesian Approach for Incorporating the EQ-5D Visual Analog Scale When Estimating the Health-Related Quality of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1575-1581. [PMID: 35304036 DOI: 10.1016/j.jval.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework. METHODS We created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data. RESULTS The combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%. CONCLUSIONS Including the EQ-VAS through Bayesian methods can add value by reducing requisite sample sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used.
Collapse
Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Nicole White
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
6
|
Leal J, Becker F, Lim L, Holman RR, Gray AM. Health utilities in Chinese patients with coronary heart disease and impaired glucose tolerance (ACE): A longitudinal analysis of a randomized, double-blind, placebo-controlled trial. J Diabetes 2022; 14:455-464. [PMID: 35876124 PMCID: PMC9310045 DOI: 10.1111/1753-0407.13294] [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] [Received: 10/11/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We estimate health-related quality of life and the impact of four cardiovascular events (myocardial infarction [MI], stroke, congestive heart failure, angina) and gastrointestinal events in 6522 Chinese patients with coronary heart disease (CHD) and impaired glucose tolerance (IGT) participating in the Acarbose Cardiovascular Evaluation (ACE) trial. METHODS Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level (EQ-5D-3L), with data collected at baseline and throughout the trial. Multilevel mixed-effects linear regression with random effects estimated health-related quality of life over time, capturing variation between hospital sites and individuals, and a fixed-effects linear model estimated the impact of cardiovascular and gastrointestinal events. RESULTS Patients were followed for a median of 5 years (interquartile range 3.4-6.0). The average baseline EQ-5D score of 0.930 (SD 0.104) remained relatively unchanged over the trial period with no evidence of statistically significant differences in EQ-5D score between randomized treatment groups. The largest decrement in the year of an event was estimated for stroke (-0.107, P < .001), followed by heart failure (-0.039, P = .022), MI (-0.021, P = .047), angina (-0.012, P = .047), and gastrointestinal events (-0.005, P = .430). MI and stroke reduced health-related quality of life beyond the year in which the event occurred (-0.031, P = .006, and -0.067, P < .001, respectively). CONCLUSIONS Acarbose treatment had no impact on health-related quality of life in ACE trial participants with CHD and IGT. Events such as MI, stroke, heart failure, and angina reduce health-related quality of life around the time they occurred, but only MI and stroke impacted on longer-term health-related quality of life.
Collapse
Affiliation(s)
- José Leal
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Frauke Becker
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Lee‐Ling Lim
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
| | | | | |
Collapse
|
7
|
Leal J, Becker F, Feenstra T, Pagano E, Jensen TM, Vistisen D, Witte DR, Jorgensen ME. Health-related quality of life for normal glycaemia, prediabetes and type 2 diabetes mellitus: Cross-sectional analysis of the ADDITION-PRO study. Diabet Med 2022; 39:e14825. [PMID: 35253278 PMCID: PMC9311436 DOI: 10.1111/dme.14825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
AIMS We estimated and compared health-related quality of life for individuals with normal glucose tolerance, prediabetes and diabetes. METHODS Participants in the ADDITION-PRO study, Denmark, who attended a health assessment between 2009 and 2011, and who completed the 3-level EuroQoL 5-dimensions (EQ-5D-3L) questionnaire were included. For the present study, they were classified as normal glucose tolerance, prediabetes and diabetes (screen-detected and known) using the 2019 American Diabetes Association criteria. Prediabetes was defined as impaired fasting glucose, impaired glucose tolerance or HbA1c between 5.7-6.4% (39-47 mmol/mol). EQ-5D-3L data were converted into utility scores using Danish and UK values, where '1' equals full health and '0' equals death. Regression models estimated the association between utility and the different glucose health states. RESULTS The mean EQ-5D-3L score in the sample population was 0.86 ± 0.17 (median 0.85, interquartile range 0.76 to 1) using UK values. Almost half of the sample (48%) reported full health with an EQ-5D score of '1'. Individuals with known diabetes reported the lowest EQ-5D-3L utility scores (0.81 ± 0.20), followed by individuals with screen-detected diabetes (0.85 ± 0.19), prediabetes (0.86 ± 0.17) and normal glucose tolerance (0.90 ± 0.15). The differences were statistically significant for normal glucose and known diabetes relative to prediabetes, after adjusting for sex, age, smoking, BMI and physical activity. These findings also held using Danish values albeit the differences were of smaller magnitude. CONCLUSIONS Having prediabetes and diabetes was significantly associated with lower health-related quality of life relative to normal glucose tolerance. Our estimates will be useful to inform the value of interventions to prevent diabetes or prediabetes.
Collapse
Affiliation(s)
- Jose Leal
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Frauke Becker
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Talitha Feenstra
- Groningen UniversityGroningen Research Institute of PharmacyGroningenThe Netherlands and RIVMBilthovenThe Netherlands
| | - Eva Pagano
- Unit of Clinical Epidemiology"Città della Salute e della Scienza" HospitalTurinItaly
- CPO PiemonteTurinItaly
| | - Troels Mygind Jensen
- Research Unit for General Practice & Danish Ageing Research CenterDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | | | - Daniel R. Witte
- Department of Public HealthAarhus UniversityAarhusDenmark
- National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Marit Eika Jorgensen
- Steno Diabetes Center CopenhagenGentofteDenmark
- National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
| |
Collapse
|
8
|
Hua X, Lung TWC, Woodward M, Salomon JA, Hamet P, Harrap SB, Mancia G, Poulter N, Chalmers J, Clarke PM. Self-rated health scores predict mortality among people with type 2 diabetes differently across three different country groupings: findings from the ADVANCE and ADVANCE-ON trials. Diabet Med 2020; 37:1379-1385. [PMID: 31967344 PMCID: PMC7496988 DOI: 10.1111/dme.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
Abstract
AIMS To explore whether there is a different strength of association between self-rated health and all-cause mortality in people with type 2 diabetes across three country groupings: nine countries grouped together as 'established market economies'; Asia; and Eastern Europe. METHODS The ADVANCE trial and its post-trial follow-up were used in this study, which included 11 140 people with type 2 diabetes from 20 countries, with a median follow-up of 9.9 years. Self-rated health was reported on a 0-100 visual analogue scale. Cox proportional hazard models were fitted to estimate the relationship between the visual analogue scale score and all-cause mortality, controlling for a range of demographic and clinical risk factors. Interaction terms were used to assess whether the association between the visual analogue scale score and mortality varied across country groupings. RESULTS The visual analogue scale score had different strengths of association with mortality in the three country groupings. A 10-point increase in visual analogue scale score was associated with a 15% (95% CI 12-18) lower mortality hazard in the established market economies, a 25% (95% CI 21-28) lower hazard in Asia, and an 8% (95% CI 3-13) lower hazard in Eastern Europe. CONCLUSIONS Self-rated health appears to predict 10-year all-cause mortality for people with type 2 diabetes worldwide, but this relationship varies across groups of countries.
Collapse
Affiliation(s)
- X. Hua
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - T. W. C. Lung
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- School of Public HealthFaculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - M. Woodward
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
- George Institute for Global HealthUniversity of OxfordOxfordUK
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | - J. A. Salomon
- Department of MedicineStanford Medical SchoolStanfordCAUSA
| | - P. Hamet
- Centre de RechercheCentre Hospitalier de l'Université de MontréalMontréalQCCanada
- Department of MedicineUniversity of MontréalMontréalQCCanada
| | - S. B. Harrap
- Department of PhysiologyUniversity of MelbourneMelbourneVICAustralia
| | - G. Mancia
- University of Milano‐BicoccaMilanItaly
| | - N. Poulter
- Imperial Clinical Trials UnitSchool of Public HealthImperial College LondonLondonUK
| | - J. Chalmers
- George Institute for Global HealthUNSW SydneySydneyNSWAustralia
| | - P. M. Clarke
- School of Population and Global HealthUniversity of MelbourneMelbourneVICAustralia
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| |
Collapse
|