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Scheuer SH, Fleetwood K, Wild SH, Jackson CA. Ethnic disparities in quality of diabetes care in Scotland: A national cohort study. Diabet Med 2024; 41:e15336. [PMID: 38718278 DOI: 10.1111/dme.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 08/13/2024]
Abstract
AIMS The aim of this study is to compare quality of diabetes care in people with type 2 diabetes by ethnicity, in Scotland. METHODS Using a linked national diabetes registry, we included 162,122 people newly diagnosed with type 2 diabetes between 2009 and 2018. We compared receipt of nine guideline indicated processes of care in the first-year post-diabetes diagnosis using logistic regression, comparing eight ethnicity groups to the White group. We compared annual receipt of HbA1c and eye screening during the entire follow-up using generalised linear mixed effects. All analyses adjusted for confounders. RESULTS Receipt of diabetes care was lower in other ethnic groups compared to White people in the first-year post-diagnosis. Differences were most pronounced for people in the: African, Caribbean or Black; Indian; and other ethnicity groups for almost all processes of care. For example, compared to White people, odds of HbA1c monitoring were: 44% lower in African, Caribbean or Black people (OR 0.56 [95% CI 0.48, 0.66]); 47% lower in Indian people (OR 0.53 [95% CI 0.47, 0.61]); and 50% lower in people in the other ethnicity group (OR 0.50 [95% CI 0.46, 0.58]). Odds of receipt of eye screening were 30%-40% lower in most ethnic groups compared to the White group. During median 5 year follow-up, differences in HbA1c monitoring and eye screening largely persisted, but attenuated slightly for the former. CONCLUSIONS There are marked ethnic disparities in routine diabetes care in Scotland in the short- and medium-term following diabetes diagnosis. Further investigation is needed to establish and effectively address the underlying reasons.
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Affiliation(s)
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Ke C, Stukel TA, Thiruchelvam D, Shah BR. Ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications: a population-based cohort study. Cardiovasc Diabetol 2023; 22:241. [PMID: 37667316 PMCID: PMC10476404 DOI: 10.1186/s12933-023-01951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND We examined ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications. METHODS We conducted a population-based cohort study in Ontario, Canada among individuals with diabetes and matched individuals without diabetes (2002-18). We fit Cox proportional hazards models to determine the associations of age at diagnosis and ethnicity (Chinese, South Asian, general population) with cardiovascular complications. We tested for an interaction between age at diagnosis and ethnicity. RESULTS There were 453,433 individuals with diabetes (49.7% women) and 453,433 matches. There was a significant interaction between age at diagnosis and ethnicity (P < 0.0001). Young-onset diabetes (age at diagnosis < 40) was associated with higher cardiovascular risk [hazard ratios: Chinese 4.25 (3.05-5.91), South Asian: 3.82 (3.19-4.57), General: 3.46 (3.26-3.66)] than usual-onset diabetes [age at diagnosis ≥ 40 years; Chinese: 2.22 (2.04-2.66), South Asian: 2.43 (2.22-2.66), General: 1.83 (1.81-1.86)] versus ethnicity-matched individuals. Among those with young-onset diabetes, Chinese ethnicity was associated with lower overall cardiovascular [0.44 (0.32-0.61)] but similar stroke risks versus the general population; while South Asian ethnicity was associated with lower overall cardiovascular [0.75 (0.64-0.89)] but similar coronary artery disease risks versus the general population. In usual-onset diabetes, Chinese ethnicity was associated with lower cardiovascular risk [0.44 (0.42-0.46)], while South Asian ethnicity was associated with lower cardiovascular [0.90 (0.86-0.95)] and higher coronary artery disease [1.08 (1.01-1.15)] risks versus the general population. CONCLUSIONS There are important ethnic differences in the association between age at diagnosis and risk of cardiovascular complications.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, 12 E-252, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
- ICES, Toronto, ON, Canada.
| | - Thérèse A Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, ON, Canada
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Makowsky MJ, Davachi S, Jones CA. eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey. JMIR Form Res 2022; 6:e29955. [PMID: 35353044 PMCID: PMC9008520 DOI: 10.2196/29955] [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: 04/27/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population. OBJECTIVE The aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians. METHODS We analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy. RESULTS The analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was "I can tell high-quality health resources from low-quality health resources on the internet" (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient -6.0, 95% CI -9.61 to -2.39). CONCLUSIONS In our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions.
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Affiliation(s)
- Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shahnaz Davachi
- Primary Health Care, Alberta Health Services, Calgary, AB, Canada
| | - Charlotte A Jones
- Faculty of Medicine, Southern Medical Program, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
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Patel J, Zamzam A, Syed M, Blanchette V, Cross K, Albalawi Z, Al-Omran M, de Mestral C. A Scoping Review of Foot Screening in Adults with Diabetes Mellitus across Canada. Can J Diabetes 2022; 46:435-440.e2. [DOI: 10.1016/j.jcjd.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 11/27/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
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Makowsky MJ, Jones CA, Davachi S. Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey. JMIR Public Health Surveill 2021; 7:e20671. [PMID: 33416506 PMCID: PMC7822722 DOI: 10.2196/20671] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/20/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background South Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management. Objective This study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians. Methods We conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4% female; n=509, 72.1% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support. Results Of all respondents, 74.6% (527/706) were internet users and 47.8% (336/703) were web-based health information seekers. In addition, 74.9% (527/704) of respondents owned a smartphone or tablet and 30.7% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7%) expressed interest in using ≥1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support. Conclusions eHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes.
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Affiliation(s)
- Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Charlotte A Jones
- Faculty of Medicine, Southern Medical Program, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Shahnaz Davachi
- Primary Health Care, Alberta Health Services, Calgary, AB, Canada
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Dahrouge S, Hogg W, Muggah E, Schrecker T. Equity of primary care service delivery for low income "sicker" adults across 10 OECD countries. Int J Equity Health 2018; 17:182. [PMID: 30541552 PMCID: PMC6292158 DOI: 10.1186/s12939-018-0892-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Despite significant investments to support primary care internationally, income-based inequities in access to quality health care are present in many high-income countries. This study aims to determine whether low- and middle-income groups are more likely to report poor quality of primary care (PC) than high-income groups cross-nationally. Methods The 2011 Commonwealth Fund Telephone Survey of Sicker Adults is a cross-sectional study across eleven countries. Respondents were recruited from randomly selected households. We used data from surveys conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We identified all questions relating to primary care performance, and categorized these into five dimensions: 1) access to care, 2) coordination 3) patient-centered care, and 4) technical quality of care. We used logistic regression with low and middle-income as the comparison groups and high-income as the referent. Results Fourteen thousand two hundred sixty-two respondents provided income data. Countries varied considerably in their extent of income disparity. Overall, 24.7% were categorized as low- and 13.9% as high-income. The odds of reporting poor access to care were higher for low- and middle-income than high-income respondents in Canada, New Zealand and the US. Similar results were found for Sweden and Norway on coordination; the opposite trend favoring the low- and middle-income groups was found in New Zealand, United Kingdom, and the United States. The odds of reporting poor patient-centered care were higher for low-income than high-income respondents in the Netherlands, Norway, and the US; in Australia, this was true for low- and middle-income respondents. On technical quality of care, the odds of reporting poor care were higher for the low- and middle-income comparisons in Canada and Norway; in Germany, the odds were higher for low-income respondents only. The odds of reporting poor technical quality of care were higher for high-income than low-income respondents in the Netherlands. Conclusion Inequities in quality PC for low and middle income groups exist on at least one dimension in all countries, including some that in theory provide universal access. More research is needed to fully understand equity in the PC sector. Electronic supplementary material The online version of this article (10.1186/s12939-018-0892-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone Dahrouge
- Department of Family Medicine and Scientist at the Bruyère Research Institute and the Institute of Clinical Evaluative Sciences, University of Ottawa, Ottawa, Canada.
| | - William Hogg
- Department of Family Medicine and Scientist at the Institut de Recherche de L'Hôpital Montfort and the Institute of Clinical Evaluative Sciences, University of Ottawa, Ottawa, Canada
| | - Elizabeth Muggah
- Department of Family Medicine, The University of Ottawa, Ottawa, Canada
| | - Ted Schrecker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Lovshin JA, Shah BR. Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal health care: A population-based study. J Diabetes Complications 2017; 31:664-668. [PMID: 28143734 DOI: 10.1016/j.jdiacomp.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
AIMS To examine retinopathy screening and treatment rates for recent immigrants compared to non-immigrants in a universal health care system. METHODS Linked health care and immigration databases were used to identify all 771,564 adults diagnosed with diabetes between 1996 and 2007, in Ontario, Canada. The cohort was stratified by their immigration status and followed until 2013 for retinopathy screening and treatment visits. RESULTS Retinopathy screening rates were low, and recent immigrants were considerably less likely to receive screening than long-term residents (≥1 examination within 1year: 37.5% vs. 50.5%, adjusted OR 0.76 [95% CI, 0.75-0.77]; ≥3 examinations within 6years: 46.6% vs. 61.9%, adjusted OR 0.77 [95% Cl, 0.76-0.79]). Immigrants were also less likely to receive surgical treatment for retinopathy, but adjustment for the frequency of screening attenuated these differences. CONCLUSIONS Despite universal access to physician services, only half of all individuals with newly-diagnosed type 2 diabetes received retinopathy screening within the first year, and recent immigrants were markedly less likely to be screened. After adjusting for screening rates, gaps in surgical treatment for retinopathy were attenuated, suggesting that treatable retinopathy may be being missed among recent immigrants because of inadequate screening.
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Affiliation(s)
- Julie A Lovshin
- Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Bhurji N, Javer J, Gasevic D, Khan NA. Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies. BMJ Open 2016; 6:e008986. [PMID: 27098819 PMCID: PMC4838706 DOI: 10.1136/bmjopen-2015-008986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. DESIGN Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). PARTICIPANTS Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. PRIMARY OUTCOME Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. RESULTS 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. CONCLUSIONS Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.
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Affiliation(s)
- N Bhurji
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - J Javer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Gasevic
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - N A Khan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Tran DT, Jorm LR, Havard A, Harris MF, Comino EJ. Variation in the use of primary care services for diabetes management according to country of birth and geography among older Australians. Prim Care Diabetes 2016; 10:66-74. [PMID: 26243389 DOI: 10.1016/j.pcd.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 06/01/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
AIMS To investigate variation according to country of birth and geography in the use of primary care services funded through Medicare Australia-Australian universal health insurance-for diabetes annual cycle of care among older overseas-born Australians with type-2 diabetes. METHODS Records of Medicare claims for medical services were linked to self-administered questionnaire data for people with type-2 diabetes enrolled in the 45 and Up Study, including 840 participants born in Italy, Greece, Vietnam, Lebanon, China, India, or the Philippines and 12,444 participants born in Australia, living in 195 statistical local areas (SLAs) in New South Wales, Australia. Study outcomes included ≥6 claims for general practitioner (GP) visits, at least one claim for specialist, optometrist, Practice Incentive Payment for completion of diabetes annual cycle of care (PIP), GP Management Plan or Team Care Arrangement (GPMP/TCA), allied health, blood tests for glycosylated haemoglobin (HbA1c) and cholesterol, and urine test for micro-albumin. Multivariable multilevel logistic regression was performed, controlling for personal socio-demographic and health characteristics and geographical area remoteness and socio-economic status. RESULTS Compared with Australia-born participants, people born in Vietnam and China had significantly lower rates of claims for allied health services (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.05-0.43, and OR 0.40, 95%CI 0.18-0.87, respectively), those born in Italy had lower rates of PIP claims (OR 0.60, 95%CI 0.39-0.92) and micro-albuminuria testings (OR 0.65, 95%CI 0.47-0.89), and those born in the Philippines had lower claims for specialist services (OR 0.59, 95%CI 0.38-0.91). Participants born in Greece and China (GP visits), Vietnam (optometrist services), and India (micro-albuminuria tests) were more likely to claims for these services than Australia-born people. Significant geographic variation was observed for all study outcomes, with the greatest variations in claims for allied health services (variation 9.3%, median odds ratio [MOR] 1.74, 95% credible interval [CrI] 1.60-2.01), PIP (7.8%, MOR 1.65, 95%CrI 1.55-1.83), and GPMP/TCA items (6.6%, MOR 1.58, 95%CrI 1.49-1.73). CONCLUSIONS Different approach among geographical areas and intervention programs for identified cultural groups and their providers are warranted to improve disparities in diabetes care.
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Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health - Faculty of Medicine, UNSW Australia (The University of New South Wales), UNSW Sydney, NSW 2052, Australia.
| | - Louisa R Jorm
- Centre for Big Data Research in Health - Faculty of Medicine, UNSW Australia (The University of New South Wales), UNSW Sydney, NSW 2052, Australia.
| | - Alys Havard
- Centre for Big Data Research in Health - Faculty of Medicine, UNSW Australia (The University of New South Wales), UNSW Sydney, NSW 2052, Australia; Centre for Health Research - School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, NSW 2052, Australia.
| | - Elizabeth Jean Comino
- Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, NSW 2052, Australia.
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Shah BR, Hwee J, Anand SS, Austin PC, Manuel DG, Hux JE. Family physician ethnicity influences quality of diabetes care for Chinese but not South Asian patients. Prim Care Diabetes 2015; 9:432-438. [PMID: 25759306 DOI: 10.1016/j.pcd.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/03/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
AIMS To determine whether sharing the same ethnicity as their family physician influenced the quality of diabetes care for Chinese and South Asian patients in Ontario, Canada. METHODS We conducted two related studies: a population-based cohort study of Chinese and South Asian patients with incident diabetes using health care administrative data (n=49,484), and a cross-sectional study of Chinese and South Asian patients with established diabetes using data collected directly from their family physicians' clinical records (n=416). In both studies, quality of care measures were compared between patients whose family physicians were or were not from the same ethnic group. RESULTS In the cohort study, Chinese patients whose family physicians were also Chinese were more likely to have a diabetes-related family physician visit and appropriate HbA1c and cholesterol testing. In the cross-sectional study, they were more likely to have foot examinations, to have microalbuminuria testing, and to achieve recommended treatment targets for HbA1c and for LDL-cholesterol. In contrast, for South Asian patients, most quality measures in either study did not differ by physician ethnicity. CONCLUSIONS Having a family physician from the same ethnic group was associated with better quality of diabetes care for Chinese but not for South Asian patients.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Jeremiah Hwee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Douglas G Manuel
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - Janet E Hux
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Barriers and Facilitators for Type-2 Diabetes Management in South Asians: A Systematic Review. PLoS One 2015; 10:e0136202. [PMID: 26383535 PMCID: PMC4575130 DOI: 10.1371/journal.pone.0136202] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/04/2015] [Indexed: 11/25/2022] Open
Abstract
Objective Although South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient’s perspectives on the barriers and facilitators to diabetes management. Methods We conducted a literature search using OVID, CINHAL and EMBASE (January, 1990 –February, 2014) evaluating the core components of diabetes management: interactions with health care providers, diet, exercise, and medication adherence. South Asian patients were self-reported as Indian, Pakistani, Malaysian-Indian or Bangladeshi origin. From 208 abstracts reviewed, 20 studies were included (19 qualitative including mixed methods studies, 1 questionnaire). Barriers and facilitators were extracted and combined using qualitative synthesis. Results All studies included barriers and few facilitators were identified. Language and communication discordance with the healthcare provider was a significant barrier to receiving and understanding diabetes education. There was inconsistent willingness to partake in self-management with preference for following their physician’s guidance. Barriers to adopting a diabetic diet were lack of specific details on South Asian tailored diabetic diet; social responsibilities to continue with a traditional diet, and misconceptions on the components of the diabetic diet. For exercise, South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise. Patients reported a lack of understanding about diabetes medication management, preference for folk and phytotherapy, and concerns about the long-term safety of diabetes medications. Facilitators included trust in care providers, use of culturally appropriate exercise and dietary advice and increasing family involvement. Overall themes for the barriers included lack of knowledge and misperceptions as well as lack of cultural adaptation to diabetes management. Conclusion Diabetes programs that focus on improving communication, addressing prevailing misconceptions, and culture specific strategies may be useful for improving diabetes management for South Asians.
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Yang J, Nijjar A, Quan H, Shah BR, Rabi D, Ignaszewski A, Khan NA. Utilization of health resources in South Asian, Chinese and white patients with diabetes mellitus. Prim Care Diabetes 2014; 8:165-170. [PMID: 24289947 DOI: 10.1016/j.pcd.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 10/29/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
AIMS We sought to determine whether there are differences in health resource utilization among South Asian (SA), Chinese and White patients with newly diagnosed diabetes mellitus. METHODS We used province-wide administrative data from British Columbia, Canada (1997-2006) to determine proportion of patients with ≥2 visits/year for all outpatient and family physician (FP) visits, proportion of patients with at least one annual visit to specialists, ophthalmology/optometry and hospital admissions by ethnic group. RESULTS There were 9529 South Asian, 14,084 Chinese and 143,630 White patients with newly diagnosed diabetes in the study. Over 90% of each of the ethnic groups visited their FP ≥2 visits/year. Chinese patients were less likely to visit FP, ophthalmology/optometrists and specialists compared to White patients. SA patients had fewer ophthalmology/optometry visits compared to White populations. White patients had higher rates of hospitalization. CONCLUSION Although all groups had high proportion of patients with appropriate frequency of FP visits, other aspects of health care utilization varied significantly by ethnicity.
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Affiliation(s)
- Jiao Yang
- Division of Cardiology, University of British Columbia, BC, Canada.
| | - Aman Nijjar
- Department of Medicine, University of British Columbia, BC, Canada; Center for Health Evaluation and Outcome Sciences, BC, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Baiju R Shah
- Division of Endocrinology, University of Toronto, ON, Canada
| | - Doreen Rabi
- Division of Endocrinology, University of Calgary, AB, Canada
| | | | - Nadia A Khan
- Department of Medicine, University of British Columbia, BC, Canada; Center for Health Evaluation and Outcome Sciences, BC, Canada
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Shah BR, Victor JC, Chiu M, Tu JV, Anand SS, Austin PC, Manuel DG, Hux JE. Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients: a population-based cohort study. Diabetes Care 2013; 36:2670-6. [PMID: 23637350 PMCID: PMC3747942 DOI: 10.2337/dc12-2105] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many non-European ethnic groups have an increased risk for diabetes; however, the published literature demonstrates considerable uncertainty about the rates of diabetes complications among minority populations. The objective of this study was to determine the risks of cardiovascular complications and of mortality after diabetes diagnosis for South Asian and Chinese patients, compared with European patients. RESEARCH DESIGN AND METHODS A population-based cohort study identified all 491,243 adults with newly diagnosed diabetes in Ontario, Canada, between April 2002 and March 2009. Subjects were followed until March 2011 for the first occurrence of any cardiovascular complication of diabetes (coronary artery disease, stroke, or lower-extremity amputation) and for all-cause mortality. Median follow-up was 4.7 years. RESULTS The crude incidence of cardiovascular complications after diabetes diagnosis was 17.9 per 1,000 patient-years among European patients, 12.0 among South Asian patients, and 7.7 among Chinese patients. After adjusting for baseline characteristics, the cause-specific hazard ratios (HRs) for cardiovascular complications relative to European patients were 0.95 (95% CI 0.90-1.00; P = 0.056) and 0.50 (0.46-0.53; P < 0.001) for South Asian and Chinese patients, respectively. Mortality was lower for both minority groups (adjusted HR for South Asian patients 0.56 [95% CI 0.52-0.60]; P < 0.001; for Chinese patients 0.58 [0.55-0.62]; P < 0.001). CONCLUSIONS Chinese patients were at substantially lower risk than European patients for cardiovascular complications after diabetes diagnosis, whereas South Asian patients were at comparable risk. Mortality after diabetes diagnosis was markedly lower for both minority populations.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Mukerji G, Chiu M, Shah BR. Gestational diabetes mellitus and pregnancy outcomes among Chinese and South Asian women in Canada. J Matern Fetal Neonatal Med 2012; 26:279-84. [PMID: 23039093 DOI: 10.3109/14767058.2012.735996] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the association between Chinese or South Asian ethnicity and adverse neonatal and maternal outcomes for women with gestational diabetes compared to the general population. METHODS A cohort study was conducted using population-based health care databases in Ontario, Canada. All 35,577 women aged 15-49 with gestational diabetes who had live births between April 2002 and March 2011 were identified. Their delivery hospitalization records and the birth records of their neonates were examined to identify adverse neonatal outcomes and adverse maternal outcomes. RESULTS Compared to infants of mothers from the general population (55.5%), infants of Chinese mothers had a lower risk of an adverse outcome at delivery (42.9%, adjusted odds ratio 0.63, 95% confidence interval 0.58-0.68), whereas infants of South Asian mothers had a higher risk (58.9%, adjusted odds ratio 1.15, 95% confidence interval 1.07-1.23). Chinese women also had a lower risk of adverse maternal outcomes (32.4%, adjusted odds ratio 0.58, 95% confidence interval 0.54-0.63) compared to general population women (41.2%), whereas the risk for South Asian women was not different (39.4%, adjusted odds ratio 0.94, 95% confidence interval 0.88-1.02) from that of general population women. CONCLUSIONS The risk of complications of gestational diabetes differs significantly between Chinese and South Asian patients and the general population in Ontario. Tailored interventions for gestational diabetes management may be required to improve pregnancy outcomes in high-risk ethnic groups.
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Affiliation(s)
- Geetha Mukerji
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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