1
|
Tremblay JO, Nahodyl L, Mesa RA, Vilchez L, Elfassy T. Low income and education are associated with greater ASCVD risk scores among adults in the US. Prev Med Rep 2024; 41:102720. [PMID: 38623580 PMCID: PMC11017042 DOI: 10.1016/j.pmedr.2024.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Social determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults. Methods Utilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999-2018 and included participants aged 40-79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design. Results Mean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K-<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K-<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education. Conclusion We found strong graded associations between lower income and lower educational attainment with greater CVD risk.
Collapse
Affiliation(s)
- Julien O. Tremblay
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Nahodyl
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Robert A. Mesa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lilliana Vilchez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tali Elfassy
- Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
2
|
Godoy-Bermúdez A, Rojo-Gallego-Burin A, Delgado-Márquez L, Martín-Martín JJ, Sánchez-Martínez MT, López del Amo-González MP. Variation in perceived health across gender, working status, educational level, and regional health care expenditure in Spain (2014-2017). PLoS One 2023; 18:e0269613. [PMID: 37450459 PMCID: PMC10348579 DOI: 10.1371/journal.pone.0269613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
A gender perspective was used to analyze whether and how education, unemployment, and per capita public health expenditure were associated with perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear and logistic specifications, we analyzed longitudinal microdata files from the Survey on Living Conditions. The results suggest that women with lower educational levels tend to report worse health than their more educated counterparts. On the other hand, women's bad health was not associated with unemployment, unlike men's. Regional per capita public health expenditure was not associated with perceived health in either men or women.
Collapse
|
3
|
Williams C, Shang D. Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study. J Med Internet Res 2023; 25:e43604. [PMID: 37171848 PMCID: PMC10185335 DOI: 10.2196/43604] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/07/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. OBJECTIVE This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. METHODS A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. RESULTS Among 2,850,831 unique patients, nearly 60% of them were female, 75% of them had a high school education or less, 49% of them were unemployed, and 62% of them identified as non-Hispanic White. Our results suggest that 9.84% of the patients had ≥1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15% (OR 1.148, 95% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12% (OR 0.875, 95% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5% (OR 0.953, 95% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor's degree or higher. Patients in the 18-44-year age group were 32% (OR 1.324, 95% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ≥65-year age group. CONCLUSIONS Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally.
Collapse
Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, United States
| | - Di Shang
- Department of Management, University of North Florida, Jacksonville, FL, United States
| |
Collapse
|
4
|
Chigariro TC, Mhloyi MM. Emigration as a social and economic determinant of health in low-income urban Zimbabwe. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:49. [PMID: 36335394 PMCID: PMC9636793 DOI: 10.1186/s41043-022-00330-w] [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: 04/10/2020] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background The negative consequences of medical professionals’ emigration on the health systems of nations are well documented in the literature. However, there is a dearth of evidence on the impact of emigration in general, on sending households’ welfare, health in particular. This study compared socio-economic characteristics, including health, of emigrants’ households with those of non-emigrants’ households in an urban setting in Harare, Zimbabwe. Methods A cross-sectional survey and focus group discussions were used to collect quantitative and qualitative data, respectively. Concurrent and retrospective data were collected using an interviewer-administered questionnaire. The target population were households, both emigrants' households and non-emigrants' households, and the interviewees were de facto heads of the respective households. Results A sample of 279 households was determined; however, 268 heads of households, a response rate of 96%, were achieved. The majority of the respondents were females (52%). Emigrants’ households were more likely to access private compared to government health care facilities, than non-emigrants’ households [P = 0.001]. Emigrants' households were also more likely to report higher incomes than non-emigrants’ households [P < 0.05] and were having more meals per day and better access to education. Emigrants' households were also more likely to report positive lifestyles than non-emigrants’ households. Only 13.8% of emigrants' households reported a negative shift in lifestyle, compared to 25.2% non-emigrants' households. Conclusions Emigration was found to have a positive relationship with health seeking, income, education, and number of meals a household had. It is clear from the findings that emigration during the hard economic times in Zimbabwe is beneficial; it cushions households from the ravages of poverty. Yet emigration robs the nation of its professional able-bodied people. It is, therefore, recommended that the government optimises the reported positive effects, whilst expeditiously working on improving the economy with the view of reversing the observed migration streams.
Collapse
|
5
|
Żarnowski A, Jankowski M, Gujski M. Nutrition Knowledge, Dietary Habits, and Food Labels Use-A Representative Cross-Sectional Survey among Adults in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11364. [PMID: 36141633 PMCID: PMC9517017 DOI: 10.3390/ijerph191811364] [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: 08/08/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
An unhealthy diet is an important risk factor for disability and premature death. This study aimed to assess nutrition knowledge, dietary habits, and food label use among adults in Poland as well as to identify factors associated with diet-related behaviors. A cross-sectional survey was carried out in July 2020 on a non-probability quota-based sample of 1070 adult citizens of Poland. The most common sources of nutrition knowledge were news websites (41.8%) or family/friends (32.4%). Over one-quarter of adults in Poland were on a diet (28.7%). Over one-tenth of respondents (11.9%) consumed less than three meals per day. Half of the respondents (50.3%) declared that they use food labels when shopping, and 15.4% checked the nutrition information on restaurant menus. Female gender (OR:1.70; 95%CI:1.26-2.29; p < 0.001), presence of chronic diseases (OR:1.83; 95%CI:1.37-2.44; p < 0.001), regular physical activity (p < 0.001), and being a non-smoker (OR:1.45; 95%CI:1.02-2.06; p = 0.04) were significantly associated with higher odds of being on a diet. Females (OR:1.63; 95%CI:1.24-2.15; p < 0.001), respondents with higher education (OR:1.53; 95%CI:1.17-2.01; p = 0.002), those who had never been married (OR:1.49; 95%CI:1.07-2.07; p = 0.02), respondents with chronic diseases (OR:1.73; 95%CI:1.30-2.31; p < 0.001), those with regular physical activity (p < 0.05), as well as non-smokers (OR:1.42; 95%CI:1.04-1.95; p = 0.03) had higher odds of checking the food labels. This study showed a significant gap in nutrition knowledge among adults in Poland.
Collapse
Affiliation(s)
- Adam Żarnowski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| |
Collapse
|
6
|
Uccheddu D, Emery T, Gauthier AH, Steverink N. Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries. ADVANCES IN LIFE COURSE RESEARCH 2022; 53:100495. [PMID: 36652213 DOI: 10.1016/j.alcr.2022.100495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 06/17/2023]
Abstract
Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.
Collapse
Affiliation(s)
- Damiano Uccheddu
- University of Louvain (UCLouvain), Louvain-la-Neuve, Belgium; Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), The Hague, the Netherlands; Department of Sociology, University of Groningen, Groningen, the Netherlands.
| | - Tom Emery
- Department of Public Administration and Sociology (DPAS), Erasmus School of Social and Behavioural Sciences (ESSB), Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Anne H Gauthier
- Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), The Hague, the Netherlands; Department of Sociology, University of Groningen, Groningen, the Netherlands.
| | - Nardi Steverink
- Department of Sociology, University of Groningen, Groningen, the Netherlands; Department of Health Psychology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands.
| |
Collapse
|
7
|
Nhengu D. Covid-19 and female migrants: policy challenges and multiple vulnerabilities. COMPARATIVE MIGRATION STUDIES 2022; 10:23. [PMID: 35669274 PMCID: PMC9155193 DOI: 10.1186/s40878-022-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
To what extent has Covid-19 policy responses exacerbated the already existing multiple vulnerabilities of female migrants in Southern Africa? Using strategic conversations, the paper explores personal experiences of key conversants, to explore how gender blind policy responses to the pandemic have heightened female migrants' socio-economic challenges. The paper recommends gender sensitive and context specific policy responses to mitigate the existing socio-economic challenges.
Collapse
|
8
|
Munro AK, Hunter EC, Hossain SZ, Keep M. A systematic review of the menstrual experiences of university students and the impacts on their education: A global perspective. PLoS One 2021; 16:e0257333. [PMID: 34506544 PMCID: PMC8432759 DOI: 10.1371/journal.pone.0257333] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Higher education attainment is linked to improved health and employment outcomes but the impact of university students’ experiences of menstruation on their education is less clear. The objective of this review was to synthesise qualitative and quantitative research on university students’ menstrual experiences and educational impacts. Methods Eligible studies were identified through systematic searching across eight peer-reviewed databases, websites for menstrual health organisations, grey literature databases, and reference lists of included studies. Eligible studies must have reported on at least one of the antecedents or components of menstrual experience outlined in the integrated model of menstrual experience in relation to university students or reported on the impact of their menstrual experiences on their education. Study characteristics and findings were extracted, analysed and presented as a narrative synthesis. The quality of evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42020178470. Results Eighty-three studies were eligible for inclusion. Most studies (n = 74; 89%) were quantitative and the highest proportion of studies were conducted in lower-middle-income countries (n = 31; 37%). Self-reported dysmenorrhea, other physical and emotional menstrual-related symptoms, and menstrual stigma contributed to negative menstrual experiences among female students. Very few studies considered the menstrual experiences of non-binary and transgender menstruating students, and culturally diverse students. Dysmenorrhea contributed to university absenteeism, impaired participation and concentration, and declining academic performance. Inadequate sanitation facilities for menstrual management and challenges containing menstruation also negatively impacted education. Conclusions Female university students’ experiences of menstruation can negatively impact their education, highlighting the need for program and policy responses at university to improve students’ wellbeing and educational engagement. Further research on the menstrual experiences of gender diverse, migrant and international students is needed as there is insufficient evidence to date.
Collapse
Affiliation(s)
- Alana K. Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Erin C. Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Syeda Z. Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Mattos S, Moreira T, Florêncio R, Cestari V. Elaboração e validação de um instrumento para mensurar Autopercepção de Saúde em adultos. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Elaborar um instrumento para mensurar a Autopercepção de Saúde (APS) em adultos e sua validação por especialistas. Estudo metodológico composto de duas fases: a primeira foi a elaboração do instrumento, a partir de revisão da literatura; a segunda, de validação de conteúdo, mediante a avaliação do instrumento por nove especialistas, profissionais da saúde. Para análise, calculou-se o Índice de Validade de Conteúdo (IVC=0,78), o teste binomial (p>0,05) e o coeficiente Kappa (=0,61). Inicialmente, o instrumento foi composto por 25 itens, dispostos em três dimensões. Um item foi eliminado (IVC=0,56) e três perguntas foram adicionadas por sugestão dos especialistas. Ao final, o instrumento foi organizado em 26 itens divididos em três dimensões. O IVC total do instrumento foi de 0,84 e Kappa igual a 0,83. O instrumento apresentou IVC satisfatório e apto para análise semântica e posterior validação externa.
Collapse
|
10
|
Asthana S, Gibson A. Averting a public health crisis in England's coastal communities: a call for public health research and policy. J Public Health (Oxf) 2021; 44:642-650. [PMID: 33982058 PMCID: PMC9424058 DOI: 10.1093/pubmed/fdab130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022] Open
Abstract
Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.
Collapse
Affiliation(s)
- Sheena Asthana
- Plymouth Institute of Health and Care Research (PIHR), University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Alex Gibson
- Plymouth Institute of Health and Care Research (PIHR), University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| |
Collapse
|
11
|
"When I Retire, I'll Move Out of the City": Mental Well-being of the Elderly in Rural vs. Urban Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072442. [PMID: 32260213 PMCID: PMC7177390 DOI: 10.3390/ijerph17072442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Abstract
This study examines the influence of risk factors on mental well-being at older ages focusing on the level of rurality of the living environment. We used cross-sectional, nationally representative survey data for Catalonia (Spain) from 2015 to 2017 to explain the mental well-being of the population aged 65 years and over. Based on a sample of 2621 individuals, we created a score of current mental well-being using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Using logistic regression and non-parametric tests, we identified the sociodemographic, health and lifestyle variables which, in combination with the features of the rural and urban settings of the living space, were associated with poor SWEMWBS scores. Our results reveal that adequate social support is linked to expectations of good mental well-being in later life. Poor self-perceived health and ageing limitations are associated with less deterioration of the well-being for the elderly living in rural areas, whereas living in urban areas is linked to a higher risk of suffering from emotional distress attributable to economic difficulties or low educational attainment. Incentivizing older people to live in rural environments could result in greater well-being in the last stages of life; appropriate prospective studies are needed to test this positive outcome.
Collapse
|
12
|
Li M, Wang Y, Liu Z, Tang X, Mu P, Tan Y, Wang J, Lin B, Deng J, Peng R, Zhang R, He Z, Li D, Zhang Y, Yang C, Li Y, Chen Y, Liu X, Chen Y. Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China. J Diabetes Res 2020; 2020:5814296. [PMID: 32377522 PMCID: PMC7191394 DOI: 10.1155/2020/5814296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the distribution of diabetic retinopathy (DR) by sex in patients with type 2 diabetes mellitus (T2DM) in a twelve-province cross-sectional study in China. METHODS Patients with T2DM, whose ages were ≥18 years, were recruited from 76 cities/counties in 12 provinces in mainland China between January 2015 and December 2018. All participants received a standardized interview, eye examinations, and digital fundus photography. The presence and severity of DR were diagnosed and classified by retina specialists according to the DR domestic typing method. RESULTS A total of 12,766 participants (5963 males and 6803 females) were eligible for this study. The total prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1% vs. 29.0%, P = 0.011). A multivariate logistic regression analysis confirmed that female sex was an independent predictor for a higher prevalence of DR after adjusting for age, the duration of diabetes, economic status, and the presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P = 0.023). Even after stratification by the diabetic duration, age, and economic status, female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years, whose ages were over 60 years, or who were in a relatively intermediate economic area. CONCLUSION Females had a higher prevalence of DR than males in T2DM patients with a diabetic history of more than 10 years, ages over 60 years, or a relatively intermediate economic status.
Collapse
Affiliation(s)
- Mei Li
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yina Wang
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zifeng Liu
- Clinical Data Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xixiang Tang
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Panwei Mu
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ying Tan
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Jing Wang
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Bairun Lin
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Juan Deng
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ruiping Peng
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Rongyu Zhang
- Guangzhou Da'an Clinical Laboratory Center Co. Ltd., Guangzhou 440100, China
| | - Zhihui He
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou 510000, China
| | - Dongling Li
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Yongjun Zhang
- Department of Endocrinology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai 519100, China
| | - Caixian Yang
- Department of Endocrinology & Metabolism, Qingyuan People's Hospital, Qingyuan 511518, China
| | - Yuan Li
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Yuming Chen
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yanming Chen
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| |
Collapse
|