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Ding X, Kharrazi H, Nishimura A. Assessing the impact of social determinants of health on diabetes severity and management. JAMIA Open 2024; 7:ooae107. [PMID: 39464797 PMCID: PMC11512144 DOI: 10.1093/jamiaopen/ooae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/31/2024] [Accepted: 10/10/2024] [Indexed: 10/29/2024] Open
Abstract
Objective Adverse Social Determinants of Health (SDoH) are considered major obstacles to effective management of type-2 diabetes. This study aims to quantify the impact of SDoH factors on diabetes management outcomes. Materials and Methods We quantified the joint impact of multiple SDoH by applying a self-control case series method-which accounts for confounding by using individuals as their own control-to electronic health record data from an academic health system in Maryland. Results We found a consistent increase in HbA1c levels associated with SDoH across alternative study designs. The estimated total contributions of SDoH ranged 0.014-0.065 across the alternative designs. Transportation issues demonstrated particularly significant contributions, with estimates of 0.077-0.144. When assuming SDoH's risk window to be ±45 days, for example, the total contribution was estimated to be 0.065 (95% CI [0.010, 0.120]) increase in HbA1c and the transportation issues' contribution 0.134 (95% CI [0.020, 0.249]). Discussion and Conclusion Our result suggests that reducing transportation barriers may be an effective SDoH intervention strategy for diabetes management; however, the clinical impact of such interventions warrants further investigation.
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Affiliation(s)
- Xiyu Ding
- Biomedical Informatics and Data Science, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Hadi Kharrazi
- Biomedical Informatics and Data Science, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, United States
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Volpert-Esmond HI, Bray JR, Pages SM, Danyluck C. Cardiovascular reactivity during conversations about discrimination is buffered by social support among U.S. Latines. Sci Rep 2024; 14:26964. [PMID: 39505989 PMCID: PMC11542084 DOI: 10.1038/s41598-024-76795-y] [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: 05/27/2024] [Accepted: 10/16/2024] [Indexed: 11/08/2024] Open
Abstract
Racial discrimination is conceptualized as an acute and chronic stressor. Like other acute stressors, lab-based studies demonstrate acute effects of discrimination-related stressors on stress-related cardiovascular outcomes, including total cardiac output, blood pressure, and indices of sympathetic and parasympathetic nervous system activity. Critically, it is important to understand how individual and social factors buffer the experience of race-related acute stress. The current study extends existing work by measuring cardiovascular indices of stress during conversations about racial/ethnic discrimination and examines the moderating role of social support. Latine/Hispanic participants (N = 97) talked about personal discrimination experiences with either a close other or a research assistant they had never previously met. Participants in both conditions exhibited cardiovascular reactivity indicative of stress during the conversation. Additionally, patterns of reactivity reflected a more adaptive stress response and recovery profile when participants talked about discriminatory experiences with a close other relative to a stranger (less parasympathetic withdrawal during the stressor and more parasympathetic rebound during recovery). These patterns are consistent with a stress buffering account of social support, which suggests social bonds and community-level support are critical to consider in interventions to mitigate the harms of experiencing discrimination and prevent chronic health disparities.
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Affiliation(s)
- Hannah I Volpert-Esmond
- Department of Psychology, University of Texas at El Paso, 500 W. University Ave, El Paso, TX, 79968, USA.
| | - Jessica R Bray
- Department of Psychology, University of Kentucky, Kastle Hall 115, Lexington, KY, 40506, USA
| | - Samantha M Pages
- Department of Psychology, University of Texas at El Paso, 500 W. University Ave, El Paso, TX, 79968, USA
| | - Chad Danyluck
- Department of Psychology, Carleton University, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
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Zvolensky MJ, Shepherd JM, Clausen BK, Robison J, Cano MÁ, de Dios M, Correa-Fernández V. Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke. J Behav Med 2024; 47:581-594. [PMID: 38409553 DOI: 10.1007/s10865-024-00480-8] [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: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Jillian Robison
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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Gupta M, Phan TLT, Lê-Scherban F, Eckrich D, Bunnell HT, Beheshti R. Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.06.08.23291145. [PMID: 37398451 PMCID: PMC10312866 DOI: 10.1101/2023.06.08.23291145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them. Impact Statement This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.
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Kanbergs A, Jorgensen K, Agusti N, Viveros-Carreño D, Wu CF, Nitecki R, Harris JA, Woodard T, Ramphul R, Rauh-Hain JA. Patient Location and Disparities in Access to Fertility Preservation for Women With Gynecologic or Breast Cancer. Obstet Gynecol 2024; 143:824-834. [PMID: 38574368 PMCID: PMC11098692 DOI: 10.1097/aog.0000000000005570] [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: 01/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the effect of geographic factors on fertility-sparing treatment or assisted reproductive technology (ART) utilization among women with gynecologic or breast cancers. METHODS We conducted a cohort study of reproductive-aged patients (18-45 years) with early-stage cervical, endometrial, or ovarian cancer or stage I-III breast cancer diagnosed between January 2000 and December 2015 using linked data from the California Cancer Registry, the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. Generalized linear mixed models were used to evaluate associations between distance from fertility and gynecologic oncology clinics, as well as California Healthy Places Index score (a Census-level composite community health score), and ART or fertility-sparing treatment receipt. RESULTS We identified 7,612 women with gynecologic cancer and 35,992 women with breast cancer. Among all patients, 257 (0.6%) underwent ART. Among patients with gynecologic cancer, 1,676 (22.0%) underwent fertility-sparing treatment. Stratified by quartiles, residents who lived at increasing distances from gynecologic oncology or fertility clinics had decreased odds of undergoing fertility-sparing treatment (gynecologic oncology clinics: Q2, odds ratio [OR] 0.76, 95% CI, 0.63-0.93, P =.007; Q4, OR 0.72, 95% CI, 0.56-0.94, P =.016) (fertility clinics: Q3, OR 0.79, 95% CI, 0.65-0.97, P =.025; Q4, OR 0.67, 95% CI, 0.52-0.88, P =.004), whereas this relationship was not observed among women who resided within other quartiles (gynecologic oncology clinics: Q3, OR 0.81 95% CI, 0.65-1.01, P =.07; fertility clinics: Q2, OR 0.87 95% CI, 0.73-1.05, P =.15). Individuals who lived in communities with the highest (51 st -100 th percentile) California Healthy Places Index scores had greater odds of undergoing fertility-sparing treatment (OR 1.29, 95% CI, 1.06-1.57, P =.01; OR 1.66, 95% CI, 1.35-2.04, P =.001, respectively). The relationship between California Healthy Places Index scores and ART was even more pronounced (Q2 OR 1.9, 95% CI, 0.99-3.64, P =.05; Q3 OR 2.86, 95% CI, 1.54-5.33, P <.001; Q4 OR 3.41, 95% CI, 1.83-6.35, P <.001). CONCLUSION Geographic disparities affect fertility-sparing treatment and ART rates among women with gynecologic or breast cancer. By acknowledging geographic factors, health care systems can ensure equitable access to fertility-preservation services.
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Affiliation(s)
- Alexa Kanbergs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Viveros-Carreño
- Unidad Ginecología oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia
- Clínica Universitaria Colombia, Bogotá, Colombia
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A. Harris
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Terri Woodard
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Alvarado C, Nguyen-Rodriguez ST, Frank GC, Garcia M, Gatdula N. Influence of Home Language Use on the Association Between Parent Education and Child Adiposity in Latino Families. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01935-z. [PMID: 38381326 DOI: 10.1007/s40615-024-01935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Parent education and language use are associated with child obesity, but the impact of their interaction is less known. This study assessed whether parent education was associated with child adiposity and if this association was moderated by home language use in Latino families. METHODS Participants (n = 415) were Latino families from the Long Beach area. Demographic data were obtained by self-report parent surveys, and children's body size was objectively assessed via bioelectric impedance. Independent t-tests and hierarchical linear regressions were performed on baseline data from a larger intervention study. RESULTS In the overall sample, parent education and child body mass index (BMI) percentile were not related (p = .050). However, stratification by home language use revealed that parent education was inversely associated with child BMI percentile among those whose primary home language was Spanish (p = .049), but not English/bilingual homes (p = .296). There were no significant associations with child percent body fat. CONCLUSION Higher education was associated with a lower BMI percentile only in Spanish-speaking homes. Research to understand how home language influences this relationship is warranted, particularly as it relates to a subset of education and health literacy. Significant results with BMI percentile but not percent body fat highlight the fact that these distinct markers of obesity are not interchangeable.
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Affiliation(s)
- Carina Alvarado
- Department of Health Science, California State University, Long Beach, CA, USA
- School of Public Health, University of California, Berkeley, CA, USA
| | - Selena T Nguyen-Rodriguez
- Department of Health Science, California State University, Long Beach, CA, USA.
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA.
| | - Gail C Frank
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
- Department of Family & Consumer Sciences, California State University, Long Beach, CA, USA
| | - Melawhy Garcia
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
| | - Natalia Gatdula
- Department of Health Science, California State University, Long Beach, CA, USA
- Center forLatino Community Health, Evaluation, and Leadership Training, Long Beach, CA, USA
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Rawat P, Sehar U, Bisht J, Reddy AP, Reddy PH. Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers. Ageing Res Rev 2024; 93:102178. [PMID: 38154509 PMCID: PMC10807242 DOI: 10.1016/j.arr.2023.102178] [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: 07/20/2023] [Revised: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA
| | - Jasbir Bisht
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Arubala P Reddy
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Hayashi D, Edwards C, Emond JA, Gilbert-Diamond D, Butt M, Rigby A, Masterson TD. What Is Food Noise? A Conceptual Model of Food Cue Reactivity. Nutrients 2023; 15:4809. [PMID: 38004203 PMCID: PMC10674813 DOI: 10.3390/nu15224809] [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: 10/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
As GLP-1 receptor agonists, like semaglutide, emerge as effective treatments for weight management, anecdotal reports from patients and clinicians alike point to a reduction in what has been colloquially termed "food noise", as patients report experiencing less rumination and obsessive preoccupation about food. In this narrative review, we discuss concepts used in studies to investigate human eating behavior that can help elucidate and define food noise, particularly food cue reactivity. We propose a conceptual model that summarizes the main factors that have been shown to determine the magnitude of the reactivity elicited by external and internal food cues and how these factors can affect short- and long-term behavioral and clinical outcomes. By integrating key research conducted in this field, the Cue-Influencer-Reactivity-Outcome (CIRO) model of food cue reactivity provides a framework that can be used in future research to design studies and interpret findings related to food noise and food cue reactivity.
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Affiliation(s)
- Daisuke Hayashi
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA (T.D.M.)
| | - Caitlyn Edwards
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA (T.D.M.)
| | - Jennifer A. Emond
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Diane Gilbert-Diamond
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Andrea Rigby
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Travis D. Masterson
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA (T.D.M.)
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Garces TS, Damasceno LLV, Sousa GJB, Cestari VRF, Pereira MLD, Moreira TMM. Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis. Rev Lat Am Enfermagem 2023; 31:e3971. [PMID: 37586008 PMCID: PMC10424900 DOI: 10.1590/1518-8345.6592.3971] [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: 12/02/2022] [Accepted: 05/28/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators. METHOD an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps. RESULTS a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (β=11.7) and the Family Health Strategy coverage (β=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil. CONCLUSION in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators. HIGHLIGHTS (1) The time-space pattern of mortality due to Diabetes presents an increasing trend. (2) The Northeast and South regions present high rates of mortality due to Diabetes. (3) Mortality due to Diabetes is associated with worse sociodemographic indicators. (4) A relationship is observed between income, access to health and mortality due to Diabetes.
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Affiliation(s)
- Thiago Santos Garces
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brasil
- Becario de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Lara Lídia Ventura Damasceno
- Becario de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil
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