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Geraets AFJ, Schram MT, Jansen JFA, Köhler S, van Boxtel MPJ, Eussen SJPM, Koster A, Stehouwer CDA, Bosma H, Leist AK. The associations of socioeconomic position with structural brain damage and connectivity and cognitive functioning: The Maastricht Study. Soc Sci Med 2024; 355:117111. [PMID: 39018997 DOI: 10.1016/j.socscimed.2024.117111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Socioeconomic inequalities in cognitive impairment may partly act through structural brain damage and reduced connectivity. This study investigated the extent to which the association of early-life socioeconomic position (SEP) with later-life cognitive functioning is mediated by later-life SEP, and whether the associations of SEP with later-life cognitive functioning can be explained by structural brain damage and connectivity. METHODS We used cross-sectional data from the Dutch population-based Maastricht Study (n = 4,839; mean age 59.2 ± 8.7 years, 49.8% women). Early-life SEP was assessed by self-reported poverty during childhood and parental education. Later-life SEP included education, occupation, and current household income. Participants underwent cognitive testing and 3-T magnetic resonance imaging to measure volumes of white matter hyperintensities, grey matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SEP, markers of structural brain damage and connectivity, and cognitive functioning. Mediation was tested using structural equation modeling. RESULTS Although there were direct associations between both indicators of SEP and later-life cognitive functioning, a large part of the association between early-life SEP and later-life cognitive functioning was explained by later-life SEP (72.2%). The extent to which structural brain damage or connectivity acted as mediators between SEP and cognitive functioning was small (up to 5.9%). CONCLUSIONS We observed substantial SEP differences in later-life cognitive functioning. Associations of structural brain damage and connectivity with cognitive functioning were relatively small, and only marginally explained the SEP gradients in cognitive functioning.
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Affiliation(s)
- Anouk F J Geraets
- Department of Social Sciences, University of Luxembourg, Esch-Sur-Alzette, Luxembourg.
| | - Miranda T Schram
- Department of Psychiatry and Neuropsychology, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands
| | - Jacobus F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands; Department of Radiology, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands; Alzheimer Centrum Limburg, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands; Alzheimer Centrum Limburg, Maastricht, The Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands; Department of Epidemiology, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands; Department of Social Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands; Department of Social Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Anja K Leist
- Department of Social Sciences, University of Luxembourg, Esch-Sur-Alzette, Luxembourg
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Meisters R, Albers J, Sezer B, de Galan BE, Eussen SJPM, Stehouwer CDA, Schram MT, van Greevenbroek MMJ, Wesselius A, Koster A, Bosma H. Socioeconomic inequalities in health-related functioning among people with type 2 Diabetes: longitudinal analyses in the Maastricht Study. BMC Public Health 2024; 24:73. [PMID: 38172697 PMCID: PMC10763122 DOI: 10.1186/s12889-023-17553-z] [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: 10/10/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common chronic disease that disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c-levels compared to people with T2DM and high SEP. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people with T2DM. METHODS Longitudinal data from 1,537 participants of The Maastricht Study with T2DM were used (32.6% female, mean (SD) age 62.9 (7.7) years). SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the Short-Form Health Survey and the Impact on Participation and Autonomy survey (all scored from 0 to 100). Associations of SEP and health-related functioning were studied annually over a 10-year period (median (IQR) 7.0 (5.0) years, baseline 2010-2018) using linear mixed methods adjusting for demographics, HbA1c-levels and lifestyle factors. RESULTS Participants with a low SEP had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.49[CI -5.77;-3.21]), mental (-2.61[-3.78,-1.44]) and social functioning (-9.76[-12.30;-7.23]) compared to participants with high income on a scale from 0 to 100. In addition, participants with a low education significantly declined more over time in mental (score for interaction education with time - 0.23[-0.37;-0.09]) and social functioning (-0.44[-0.77;-0.11]) compared to participants with high education. Participants with low and intermediate incomes significantly declined more over time in physical functioning (-0.17 [-0.34, -0.01 and - 0.18 [-0.36, 0.00]) compared to participants with high income. CONCLUSIONS Among people with T2DM, those with a lower SEP had worse health-related functioning in general than people with a higher SEP. Additionally, people with T2DM and low education developed poorer mental and social functioning over time compared to people with T2DM and high education. People with T2DM and low or intermediate income declined more in physical functioning over time than those with high incomes. In addition to HbA1c-levels and lifestyle patterns, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM.
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Affiliation(s)
- Rachelle Meisters
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Jeroen Albers
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Bengisu Sezer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simone J P M Eussen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | | | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Lares-Villaseñor E, Salazar-García S, Cossío-Torres PE, Medina-Jasso DL, Aradillas-García C, Portales-Pérez DP, Vargas-Morales JM. Glycemia and associated factors in a pediatric population in Mexico. Front Pediatr 2023; 11:1172837. [PMID: 37266538 PMCID: PMC10230080 DOI: 10.3389/fped.2023.1172837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
Aims In this study, we evaluated the association of sociodemographic, lifestyle and cardiometabolic factors with blood glucose levels in children and adolescents in Mexico. Methods An analytical cross-sectional study of 642 children and adolescents aged 6 to 19 years from different educational centers located in municipalities of the state of San Luis Potosí, Mexico, was carried out. Pearson χ2 and Spearman correlation tests and multiple linear regression models were used to evaluate the associations of the variables with glycemia. Results The prevalence of prediabetes was 8.0% in both sexes. Male participants were more likely to develop hyperglycemia than female participants (OR 2.7, 95% CI: 1.5-5.0). The variables associated with glucose levels were male sex, high socioeconomic status, inadequate diet, high blood pressure, and increased total cholesterol, LDL cholesterol, and triglycerides, which also explained up to 15.6% (p < 0.05) of the variability in glucose concentrations. Conclusion The detection of sociodemographic, lifestyle and cardiometabolic factors in children and adolescents will contribute to the implementation of prevention strategies for cardiometabolic diseases, among which prediabetes is common.
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Affiliation(s)
- E. Lares-Villaseñor
- Laboratorio de Análisis Clínicos, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - S. Salazar-García
- Laboratorio de Análisis Clínicos, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - P. E. Cossío-Torres
- Departamento de Salud Pública, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - D. L. Medina-Jasso
- Laboratorio de Análisis Clínicos, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - C. Aradillas-García
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - D. P. Portales-Pérez
- Centro de Investigación en Ciencias de la Salud y Biomedicina (CICSaB), Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
| | - J. M. Vargas-Morales
- Laboratorio de Análisis Clínicos, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, Mexico
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Gardner MP, Wang J, Hazlehurst JM, Sainsbury C, Blissett J, Nirantharakumar K, Thomas N, Bellary S. Risk of progression from pre-diabetes to type 2 diabetes in a large UK adult cohort. Diabet Med 2023; 40:e14996. [PMID: 36308066 PMCID: PMC10099224 DOI: 10.1111/dme.14996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022]
Abstract
AIMS People with pre-diabetes are at high risk of progressing to type 2 diabetes. This progression is not well characterised by ethnicity, deprivation and age, which we describe in a large cohort of individuals with pre-diabetes. METHODS A retrospective cohort study with The Health Improvement Network (THIN) database was conducted. Patients aged 18 years and over and diagnosed with pre-diabetes [HbA1c 42 mmol/mol (6.0%) to 48 mmol/mol (6.5%) were included]. Cox proportional hazards regression was used to calculate adjusted hazard rate ratios (aHR) for the risk of progression from pre-diabetes to type 2 diabetes for each of the exposure categories [ethnicity, deprivation (Townsend), age and body mass index (BMI)] separately. RESULTS Of the baseline population with pre-diabetes (n = 397,853), South Asian (aHR 1.31; 95% CI 1.26-1.37) or Mixed-Race individuals (aHR 1.22; 95% CI 1.11-1.33) had an increased risk of progression to type 2 diabetes compared with those of white European ethnicity. Likewise, deprivation (aHR 1.17; 95% CI 1.14-1.20; most vs. least deprived) was associated with an increased risk of progression. Both younger (aHR 0.63; 95% CI 0.58-0.69; 18 to <30 years) and older individuals (aHR 0.85; 95% CI 0.84-0.87; ≥65 years) had a slower risk of progression from pre-diabetes to type 2 diabetes, than middle-aged (40 to <65 years) individuals. CONCLUSIONS South Asian or Mixed-Race individuals and people with social deprivation had an increased risk of progression from pre-diabetes to type 2 diabetes. Clinicians need to recognise the differing risk across their patient populations to implement appropriate prevention strategies.
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Affiliation(s)
- Michael P. Gardner
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jingya Wang
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | | - Chris Sainsbury
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | | | | - Neil Thomas
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
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Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran. Sci Rep 2022; 12:17892. [PMID: 36284227 PMCID: PMC9596718 DOI: 10.1038/s41598-022-22779-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023] Open
Abstract
We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35-70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p < 0.001), Increasing body mass index (BMI) (p < 0.05), ex-smoker (p < 0.01), family history of diabetes (FHD) (p < 0.001), and comorbidity (p < 0.001) were independent risk factors for DM. Age group of 46-60 (p < 0.05), ex-smoker (p < 0.05), FHD (p < 0.05) were increased chance of awareness. Current smokers (p < 0.05), and higher education increase the chance of glycemic control in DM. Both DM (RCI = - 0.234) and prediabetes (RCI = - 0.122) were concentrated significantly among less-educated participants. DM was concentrated significantly among poor (RCI = - 0.094) people. A significant proportion of DM awareness and treatment can be due to the integration of diabetes into the primary health care system. The high prevalence of prediabetes and diabetes, which is affected by socioeconomic inequality and combined with low levels of glycemic control may place a greater burden on the health system. Therefore, awareness, receiving treatment, and glycemic control in people with diabetes, and the socioeconomic status of people have become increasingly important in the near future.
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Chan CY, Hoi BPK, Wong ELY. Lay health worker intervention in pre-diabetes management: Study protocol of a pragmatic randomized controlled trial for Chinese families living in inadequate houses. Front Public Health 2022; 10:957754. [PMID: 36299765 PMCID: PMC9589092 DOI: 10.3389/fpubh.2022.957754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Lay health workers, despite their lack of formal trainings, are important partners in providing accessible care to people with risk to develop diabetes in the community. While pre-diabetes and diabetes are more prevalent among people with low socio-economic status, including those living in inadequate houses. However, this population often have accessibility problems to formal care services due to their financial and social disadvantages. In a high-income, developed Chinese society, this pragmatic randomized controlled trial seeks to investigate the effect of a 6-months lay health worker intervention in diabetes management among people living in sub-divided flats units in Hong Kong. Methods and analysis In this trial, 222 Chinese primary caregivers living in inadequate houses and with diabetes risk will be recruited via non-profit organizations serving in districts with low average household incomes and prevalent subdivided flats in Hong Kong. Adopting a 6 months wait-list control, participants will be randomized to receive a 6-months lay health worker intervention of 5 components, including (1) lay health worker training and support; (2) health professional training; (3) formulation of a targeted care plan for the health and nutritional needs of the families; (4) case management approach; and (5) financial subsidy for lay health workers to sustain the practice. The control group will receive usual care and health information on diabetes risk management. Glycated hemoglobin (HbA1c) and fasting blood glucose will be taken at the entry and exit assessment of this trial as primary outcomes. Discussion Our randomized controlled trial is one of the first to investigate the effect of lay health worker intervention on pre-diabetes management in a low-income Chinese population residing in inadequate houses. This study could provide insights to consider alternative service provision models to people living with diabetes risk in the community, by providing a care option to be supported by community health workers and enhanced community participation of care providers. This study attempts to evaluate the impact of a lay health worker intervention using a mixed-method study design. Despite its contribution, this study might be subjected to sampling bias since all the participants will be recruited from non-profit organizations serving deprived populations. Trial registration number ChiCTR2100052080 in Chinese Clinical Trial Registry. URL: https://www.chictr.org.cn/edit.aspx?pid=134928&htm=4.
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Affiliation(s)
- Crystal Ying Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Becky Pek-kei Hoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Eliza Lai-yi Wong
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Lifecourse socioeconomic position and diabetes incidence in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, 2003 to 2016. Prev Med 2021; 153:106848. [PMID: 34673080 PMCID: PMC8658048 DOI: 10.1016/j.ypmed.2021.106848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
Low socioeconomic position (SEP) across the lifecourse is associated with Type 2 diabetes (T2DM). We examined whether these economic disparities differ by race and sex. We included 5448 African American (AA) and white participants aged ≥45 years from the national (United States) REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort without T2DM at baseline (2003-07). Incident T2DM was defined by fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, or using T2DM medications at follow-up (2013-16). Derived SEP scores in childhood (CSEP) and adulthood (ASEP) were used to calculate a cumulative (CumSEP) score. Social mobility was defined as change in SEP. We fitted race-stratified logistic regression models to estimate the association between each lifecourse SEP indicator and T2DM, adjusting for covariates; additionally, we tested SEP-sex interactions. Over a median of 9.0 (range 7-14) years of follow-up, T2DM incidence was 167.1 per 1000 persons among AA and 89.9 per 1000 persons among white participants. Low CSEP was associated with T2DM incidence among AA (OR = 1.61; 95%CI 1.05-2.46) but not white (1.06; 0.74-2.33) participants; this was attenuated after adjustment for ASEP. In contrast, low CumSEP was associated with T2DM incidence for both racial groups. T2DM risk was similar for stable low SEP and increased for downward mobility when compared with stable high SEP in both groups, whereas upward mobility increased T2DM risk among AAs only. No differences by sex were observed. Among AAs, low CSEP was not independently associated with T2DM, but CSEP may shape later-life experiences and health risks.
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Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910177. [PMID: 34639477 PMCID: PMC8508269 DOI: 10.3390/ijerph181910177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 01/06/2023]
Abstract
Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults.
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Life-course pathways from childhood socioeconomic status to type 2 diabetes in mid-late Chinese adulthood. Sci Rep 2021; 11:13051. [PMID: 34158532 PMCID: PMC8219676 DOI: 10.1038/s41598-021-91768-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
The relationship between childhood socioeconomic status (SES) and type 2 diabetes (T2D) remains inconclusive, and the pathways and mechanisms driving this relationship have yet to be clarified. This study aimed to examine the pathways linking childhood SES to T2D prevalence in mid-late adulthood in a low- and middle-income country. The incidence of T2D diagnosed in mid-late Chinese adulthood was assessed using self-reports from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was assessed by the education, occupation, survivorship of the parents and the financial situation of the family, whereas adulthood SES was assessed by education and wage. This study performed structural equation modeling to clarify the direct and indirect pathways from childhood SES to T2D via childhood health, childhood food shortage, adulthood SES and physical activity. A total of 15,132 participants were included, and the prevalence of T2D was 5.24%. This study found that childhood SES was directly associated with T2D in mid-late adulthood, the probability of developing T2D increased by 9.20% of the standard deviation for each decrease in standard deviation in childhood SES. Childhood SES was indirectly associated with T2D via adulthood SES, physical activity, childhood health and food shortage. Adulthood SES and physical activity mainly mediated the indirect pathway from childhood SES and T2D. This study showed direct and indirect pathways from disadvantaged childhood SES to increased risk of T2D in mid-late Chinese adulthood. Childhood SES, adulthood SES, physical activity, childhood health and food shortage were identified as life-course interventional targets that should be considered in the development of effective strategies to reduce the burden of T2D and SES-related health inequities in childhood.
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Tiozzo E, Rodriguez A, Konefal J, Farkas GJ, Maher JL, Lewis JE. The Relationship between HIV Duration, Insulin Resistance and Diabetes Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083926. [PMID: 33918016 PMCID: PMC8068399 DOI: 10.3390/ijerph18083926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
The risk of developing Type 2 Diabetes Mellitus in people living with HIV (PLWH) can be four times greater and can occur at an earlier age and even without the presence of obesity compared to those without HIV. Therefore, the purpose of this analytical cross-sectional study was to determine the relationship between HIV duration and glucose metabolism among PLWH. Eighty-two PLWH were categorized into shorter (≤15 years) or longer HIV duration (≥16 years) and then compared for differences in demographics, physical and clinical characteristics, biomarkers, and dietary intake. Compared to those with shorter HIV duration (n = 34), those with longer HIV duration (n = 48) were on average older (p = 0.02), reported lower consumption of alcohol (p = 0.05), had higher levels of homeostasis model assessment of insulin resistance (HOMA-IR, p = 0.02), were also more likely to be a woman (p = 0.06), and have higher levels of fasting insulin (p = 0.06). When adjusted for age and body weight, the levels of HOMA-IR and fasting insulin were higher (p = 0.02 and p = 0.04) with longer compared to shorter HIV duration, respectively. Longer exposure to HIV infection is associated with impaired insulin sensitivity. Continuing research aimed at the long-term effects of HIV infection and (antiretroviral therapy) is required.
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Affiliation(s)
- Eduard Tiozzo
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- Correspondence: ; Tel.: +44-305-243-1633
| | - Allan Rodriguez
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Janet Konefal
- Department of Family Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | | | - John E. Lewis
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Bean C, Sewell K, Jung ME. A winning combination: Collaborating with stakeholders throughout the process of planning and implementing a type 2 diabetes prevention programme in the community. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:681-689. [PMID: 31795016 DOI: 10.1111/hsc.12902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 05/16/2023]
Abstract
Translation of efficacious health interventions into the community are often not applied in practice. The gap between research and practice is concerning for community members who can benefit from early access to effective health interventions. Knowledge translation activities and strong community partnerships are demonstrated methods to close the gap, yet there is a need to ensure research findings are implemented into communities in a way that yields quality programming and sustainability through planning, preparation and time to foster the partnership. This paper outlines the collaborative process of translating a successful, evidence-based diet and exercise diabetes prevention programme for improving health and exercise adherence into a community setting through the partnership between the Diabetes Prevention Research Group and YMCA of Okanagan within British Columbia, Canada. Initiated in 2017, the process involved formalised translation events and programme piloting enabling the team to work towards a successful partnership. Lessons learned and next steps in working collaboratively towards programme scale-up and sustainability are outlined.
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Affiliation(s)
- Corliss Bean
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia
| | | | - Mary E Jung
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia
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12
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Glover LM, Cain-Shields LR, Wyatt SB, Gebreab SY, Diez-Roux AV, Sims M. Life Course Socioeconomic Status and Hypertension in African American Adults: The Jackson Heart Study. Am J Hypertens 2020; 33:84-91. [PMID: 31420642 PMCID: PMC6931894 DOI: 10.1093/ajh/hpz133] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans. METHODS Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval-CI) of baseline (2000-2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother's education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005-2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence. RESULTS High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension. CONCLUSION Efforts to prevent hypertension among African Americans should consider childhood and current SES status.
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Affiliation(s)
- Láshauntá M Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA
| | - Loretta R Cain-Shields
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sharon B Wyatt
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Ana V Diez-Roux
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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13
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A multilevel life course perspective on type 2 diabetes. JAAPA 2019; 32:34-38. [PMID: 31770303 DOI: 10.1097/01.jaa.0000604868.56572.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of type 2 diabetes has increased over the past 3 decades, particularly among adolescents as obesity also increases in this age group. Given the long-term effects associated with type 2 diabetes, public health intervention is needed. However, simply advising a patient to lose weight and increase physical exercise ignores the complex interplay of many levels of influences throughout a patient's life. This article describes type 2 diabetes from a multilevel life course perspective that can help clinicians find areas of possible intervention and understand the challenges patients face.
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Danquah I, Addo J, Boateng D, Klipstein-Grobusch K, Meeks K, Galbete C, Beune E, Bahendeka S, Spranger J, Mockenhaupt FP, Stronks K, Agyemang C, Schulze MB, Smeeth L. Early-life factors are associated with waist circumference and type 2 diabetes among Ghanaian adults: The RODAM Study. Sci Rep 2019; 9:10848. [PMID: 31350427 PMCID: PMC6659619 DOI: 10.1038/s41598-019-47169-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
Early-life experiences may fuel the emergence of obesity and type 2 diabetes among African populations. We evaluated childhood socio-economic status (SES) and childhood nutritional status as risk factors for increased waist circumference and type 2 diabetes among Ghanaian adults. In the multi-center, cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study, we calculated associations (adjusted for demographics and lifestyle) of parental education and anthropometric markers of childhood nutrition [leg length, leg length-to-height ratio (LHR)] with waist circumference and type 2 diabetes, respectively. Among 5,575 participants (mean age: 46.2 years; 62% female), lower education of either parent (vs. higher) was consistently associated with higher waist circumference (∆: 1.6-3.4 cm). Lower father's education tended to increase the odds of type 2 diabetes by 50% in women (95% confidence interval (CI): 1.0, 2.4). Reduced leg length and LHR were associated with higher waist circumference. But only in men, leg length was inversely related to type 2 diabetes (OR per 1 standard deviation decrease: 1.1; 95% CI: 1.0, 1.3). In this study, markers of poor childhood SES and early-life nutritional status relate to abdominal obesity in men and women and to type 2 diabetes in men. Thus, prevention efforts should start in early childhood.
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Affiliation(s)
- Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany. .,Charité - Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany.
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karlijn Meeks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Erik Beune
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Silver Bahendeka
- Mother Kevin Postgraduate Medical School (MKPGMS), Uganda Martyrs University, Kampala, Uganda
| | - Joachim Spranger
- Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin & Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism; DZHK (German Centre for Cardiovascular Research), partner site Berlin; Center for Cardiovascular Research (CCR), Berlin, Germany
| | - Frank P Mockenhaupt
- Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin & Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Besser A, Döhnert M, Stadelmann S. [Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:345-358. [PMID: 31099287 DOI: 10.1024/1422-4917/a000668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Various socioeconomic factors as predictors of internalizing and externalizing disorders in children and adolescents Abstract. Objective: Socioeconomic status (SES) is an important risk factor for psychiatric disorders in children and adolescents. Various SES parameters are included in research efforts. This paper investigates the predictive value of different individual SES measures and the combination thereof regarding internalizing and externalizing disorders in children and adolescents. Method: We used data from N = 381 8- to 14-year-olds who had been recruited in child and adolescent psychiatric facilities and in the general population. Based on a diagnostic parent interview (K-SADS-PL), we divided the sample into internalizing and externalizing groups and a healthy control group. The SES data of both parents were collected. Education, occupational status, and income were integrated as single factors as well as combined factor to form the SES index. Additionally, we assessed unemployment. Results: Using multivariate analyses, we controlled for age and sex. All single factors turned out to be significant risk factors for internalizing and externalizing disorders. Occupational status was the most important single factor. The explained variance for the SES index was as high as for occupational status. Unemployment was not predictive when examined simultaneously with the SES index. Conclusion: Future studies should integrate the SES as risk factor and use the SES index or occupational status as single factor. The integration of unemployment is not necessarily needed.
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Affiliation(s)
- Anna Besser
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig.,2 HELIOS Hanseklinikum Stralsund GmbH, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Stralsund
| | - Mirko Döhnert
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
| | - Stephanie Stadelmann
- 1 LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig Universitätsklinikum Leipzig - AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
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16
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Qi Y, Koster A, van Boxtel M, Köhler S, Schram M, Schaper N, Stehouwer C, Bosma H. Adulthood Socioeconomic Position and Type 2 Diabetes Mellitus-A Comparison of Education, Occupation, Income, and Material Deprivation: The Maastricht Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1435. [PMID: 31018480 PMCID: PMC6517950 DOI: 10.3390/ijerph16081435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/10/2019] [Accepted: 04/20/2019] [Indexed: 01/24/2023]
Abstract
In an effort to better quantify the impact of adulthood socioeconomic circumstances on prediabetes and type 2 diabetes (T2DM), we set out to examine the relative importance of four adulthood socioeconomic indicators. Using cross-sectional data from The Maastricht Study on 2011 middle-aged older men and women, our findings indicate that low educational level (OR = 1.81, 95% CI = 1.24-2.64), low occupational level (OR = 1.42, 95% CI = 0.98-2.05), and material deprivation (OR = 1.78, 95% CI = 1.33-2.38) were independently associated with T2DM. Low income (OR = 1.28, 95% CI = 0.88-1.87) was the strongest, albeit not significant, SEP (socioeconomic position) correlate of prediabetes. This association confirms SEP as a multifaceted concept and indicates the need to measure SEP accordingly. In order to tackle the social gradient in prediabetes and T2DM, one should, therefore, address multiple SEP indicators and their possible pathways.
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Affiliation(s)
- Yuwei Qi
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands.
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Miranda Schram
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Nicolaas Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG Maastricht, The Netherlands.
| | - Coen Stehouwer
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
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17
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Abstract
PURPOSE OF REVIEW Using a global perspective, this review collates evidence on the heterogeneity of prediabetes definitions and diagnostic methods, their clinical and public health implications, and discusses possible options for improvement. RECENT FINDINGS Our review notes that the concept of prediabetes is increasingly recognized worldwide, but against a background of non-uniform definition and diagnostic criteria. This results in widely varying burden estimation. Current evidence shows a variety of prediabetes phenotypes. This reflects biological and diagnostic heterogeneity, resulting from the use of different tests (glucose or HbA1C) and thresholds to define prediabetes. The biological and diagnostic variabilities have implications for the characterization of the burden of prediabetes, natural history, prognosis, screening, implementation of lifestyle or drug interventions to mitigate related health risks, and monitoring of the effects of such interventions.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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18
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Schrijnders D, Hendriks SH, Kleefstra N, Vissers PAJ, Johnson JA, de Bock GH, Bilo HJG, Landman GWD. Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49). PLoS One 2018; 13:e0190870. [PMID: 29370205 PMCID: PMC5784905 DOI: 10.1371/journal.pone.0190870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes and obesity seem to be partly overlapping risk factors for the development of obesity-related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population. Methods This study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group. Results Women with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95%CI: 1.63–1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95%CI 1.11–1.64 and SIR: 2.21; 95%CI 1.94–2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95%CI 1.94–2.30). Conclusions Women with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.
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Affiliation(s)
- Dennis Schrijnders
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Diabetes Centre, Zwolle, the Netherlands
- * E-mail:
| | | | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | | | | | - Geertruida H. de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Zwolle, the Netherlands
| | - Gijs W. D. Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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