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Vyas MV, Redditt V, Mohamed S, Abraha M, Sheth J, Shah BR, Ko DT, Ke C. Determinants, Prevention, and Incidence of Cardiovascular Disease Among Immigrant and Refugee Populations. Can J Cardiol 2024; 40:1077-1087. [PMID: 38387721 DOI: 10.1016/j.cjca.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
Immigration policies shape the composition, socioeconomic characteristics, and health of migrant populations. The health of migrants is also influenced by a confluence of social, economic, environmental, and political factors. Immigrants and refugees often face various barriers to accessing health care because of factors such as lack of familiarity with navigating the health care system, language barriers, systemic racism, and gaps in health insurance. Social determinants of health and access to primary care health services likely influence the burden of cardiovascular risk factors among immigrants. The relatively low burden of many cardiovascular risk factors in many immigrant populations likely contributes to the generally lower incidence rates of acute myocardial infarction, heart failure, and stroke in immigrants compared with nonimmigrants, although cardiovascular disease incidence rates vary substantially by country of origin. The "healthy immigrant effect" is the hypothesis that immigrants to high-income countries, such as Canada, are healthier than nonimmigrants in the host population. However, this effect may not apply universally across all immigrants, including recent refugees, immigrants without formal education, and unmarried immigrants. As unfolding sociopolitical events generate new waves of global migration, policymakers and health care providers need to focus on addressing social and structural determinants of health to better manage cardiovascular risk factors and prevent cardiovascular disease, especially among the most marginalized immigrants and refugees.
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Affiliation(s)
- Manav V Vyas
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Neurology, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health, Toronto, Ontario, Canada
| | - Vanessa Redditt
- Crossroads Clinic, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sebat Mohamed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mosana Abraha
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Javal Sheth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Dennis T Ko
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Schulich Heart Centre, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Cho H, Jeoung S, Kang C, Jang S. Comparative analysis of cardio-cerebrovascular complications in immigrants and native-born Koreans with diabetes: Risk factors and perspectives. PLoS One 2022; 17:e0263046. [PMID: 35486634 PMCID: PMC9053795 DOI: 10.1371/journal.pone.0263046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Given the rapidly increasing number of immigrants, it is crucial to address health care issues involving immigrants to facilitate their safe and secure settlement. Especially for common chronic diseases, such as diabetes, immigrants face more complex obstacles to manage their chronic conditions than do native-born residents. Therefore, we aimed to assess differences in the incidence and associated risk factors of cardio-cerebrovascular (CCV) complications of immigrants compared with native-born Koreans with diabetes. Methods Immigrants and native-born Koreans who had new diagnosis of diabetes and simultaneously received anti-diabetic prescriptions in 2012 were defined by using Korean National Health Insurance Claim Database(KNHICD). CCV complications were assessed at a 3-year follow-up from the index date. We assessed differences in the CCV complications and risk factors using multiple cox regression models. Results In total, 4,008 patients (668 of immigrants and 3,340 of native-born Koreans) who had newly diagnosed diabetes and simultaneously received anti-diabetic prescriptions in 2012 were selected. Immigrants with diabetes were at a 1.39 times higher risk of having CCV complications than native-born Koreans with diabetes (95% CI: 1.021–1.881). Patients who had a usual sources of care (USC) presented a significantly reduced risk of cardio-cerebrovascular complication (HR: 0.452; 95% CI: 0.342–0.598) in both immigrants and native Koreans. In subgroup analysis in immigrants, patients having USC showed decreased risk of CCV incidence (HR: 0.35, 95% CI: 0.175–0.703), whereas >60 years old and Charlson comorbidity index (CCI) score >1 presented increased risk of CCV complications. Conclusion Immigrants with diabetes have a higher risk of CCV complications than native-born Koreans with diabetes. However, having a USC significantly decreased the risk of CCV complications. Therefore, the utilization of USC will benefit to reduce diabetic complications in immigrants as well as reduction of overall health care cost burden, it would be necessary to implement USC in diabetes care at the initial disease stage.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Sohyun Jeoung
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America
- Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Cinoo Kang
- Department of Biostatics and Epidemiology Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * E-mail:
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Sekhar RV. ‘Analogy-Based Comprehensive Diabetes Education’ (ABCDE) Improves Glycemic Control of Diabetic Patients in an Underserved Population: Results of a Retrospective Chart Analysis. Healthcare (Basel) 2022; 10:healthcare10030409. [PMID: 35326887 PMCID: PMC8953270 DOI: 10.3390/healthcare10030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Diabetes is the leading global cause for blindness, kidney failure and amputations. Preventing these complications requires optimal glycemic control, and it is imperative that diabetic patients understand the fundamental concepts of diabetes care. Although patients attend formal diabetes education classes, many do not comprehend basic concepts of diabetes, and are often noncompliant with diet, exercise and medications. A novel approach termed ‘analogy-based comprehensive diabetes education’ (ABCDE) was developed to educate HIV-patients with diabetes about basic concepts of diabetes care. The object of this manuscript is to report the results of a retrospective chart review on the impact of ABCDE on glycemic outcomes in 24 patients who had failed usual care (including formal diabetes education, physician visits, and diabetic medications), and were non-adherent with diet and medications. They received only the ABCDE without any changes in pharmacotherapy. The impact on glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) was assessed at subsequent visits. HbA1c was found to decline by 22% and 33% after 3 and 6 months, respectively, with corresponding declines in FBG by 53% and 59%, respectively. These results suggest that ABCDE in outpatient diabetes clinics could be effective in behavior modification toward improving glycemic control, and warrants additional investigation.
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Affiliation(s)
- Rajagopal V Sekhar
- Section of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
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Language proficiency and warfarin-related adverse events in older immigrants and Canadian residents: a population-based cohort study. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Martinez-Cardoso A, Jang W, Baig AA. Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US. Curr Diab Rep 2020; 20:48. [PMID: 32857197 PMCID: PMC9328159 DOI: 10.1007/s11892-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA. RECENT FINDINGS While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.
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Affiliation(s)
- Aresha Martinez-Cardoso
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC 2000, Chicago, IL, 60637, USA.
| | - Woorin Jang
- The College, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Access to Norwegian healthcare system - challenges for sub-Saharan African immigrants. Int J Equity Health 2019; 18:125. [PMID: 31412853 PMCID: PMC6693278 DOI: 10.1186/s12939-019-1027-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immigrants face barriers in accessing healthcare services in high-income countries. Inequalities in health and access to healthcare services among immigrants have been previously investigated. However, little is known on the sub-Saharan African immigrants' (SSA) access to the Norwegian healthcare system. METHODS The study had a qualitative research design. We used the snowball technique to recruit participants from networks including faith-based organizations and cultural groups. Forty-seven qualitative in-depth interview and two focus group discussions with immigrants from sub-Saharan African were conducted from October 2017 to July 2018 in Oslo and its environs. Interviews were conducted in Norwegian, English or French, audio-recorded and transcribed verbatim into English. The analysis was based on a thematic approach, using NVivo software. Interview data were analyzed searching for themes and sub-themes that emerged inductively from the interviews. RESULTS Our findings reveal barriers in two main categories when accessing the Norwegian healthcare services. The first category includes difficulties before accessing the healthcare system (information access, preference for doctors with an immigrant background, financial barriers, long waiting time and family and job responsibility). The second category includes difficulties experienced within the system (comprehension/expression and language, the black elephant in the room and dissatisfaction with healthcare providers). CONCLUSION Healthcare is not equally accessible to all Norwegian residents. This ultimately leads to avoidance of the healthcare system by those most in need. Lack of seeking healthcare services by immigrants from Sub Saharan Africa may have significant implications for the long-term health of this group of immigrants. Therefore measures to address the issues raised should be prioritized and further examined.
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Affiliation(s)
- Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A Gele
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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Hushie M. Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana. Health Promot Perspect 2019; 9:223-232. [PMID: 31508343 PMCID: PMC6717922 DOI: 10.15171/hpp.2019.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective ofthis study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana. Methods: A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from the specialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using in-depth interviews, which were recorded and transcribed; and non-participant observational field notes-that were analyzed thematically through directed content analysis. Results: The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2)recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/pretense of being well). Conclusion: Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients' specific needs, guiding patients on how tomanage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.
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Affiliation(s)
- Martin Hushie
- University for Development Studies, School of Allied Health Sciences Department of Behavioural Sciences, P. O. Box 1883, Tamale, N/R Ghana
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Siddiqi L, VanAarsen K, Iansavichene A, Yan J. Risk Factors for Adverse Outcomes in Adult and Pediatric Patients With Hyperglycemia Presenting to the Emergency Department: A Systematic Review. Can J Diabetes 2019; 43:361-369.e2. [PMID: 30846250 DOI: 10.1016/j.jcjd.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Abstract
Hyperglycemia is a significant cause of morbidity and mortality, often resulting in adverse outcomes. This review aimed to identify predictors of adverse outcomes, such as repeated hospital visits, hospitalization or death, in patients presenting to the emergency department (ED) with hyperglycemia. Electronic searches of Medline and EMBASE were conducted for studies in English of patients presenting to the ED with hyperglycemia. Both adult and pediatric populations were included, with and without diabetes. Two reviewers independently screened all titles and abstracts for relevance. If consensus was not reached, full-length manuscripts were reviewed. For discrepancies, a third reviewer was consulted. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study- and patient-specific data were extracted and presented descriptively. Eight observational studies were reviewed; they included a total of 96,970 patients. Predictors of adverse outcomes included age, lowest income quintile, urban dwellers, presence of comorbidities, coexisting hyperlactatemia, having a family physician, elevated serum creatinine level, diabetes managed with insulin, sentinel visit for hyperglycemia in the past month, and high blood glucose level measured in the ED. Conflicting evidence was found for whether known history of diabetes was associated with risk. Factors associated with favourable outcomes included systolic blood pressure of 90 to 150 mmHg and tachycardia. This systematic review found 12 factors associated with adverse outcomes, and 2 factors associated with more favourable outcomes in patients presenting to the ED with hyperglycemia. These factors should be considered for easier identification of patients at higher risk for adverse outcomes to guide management and follow up.
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Affiliation(s)
- Lubna Siddiqi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Kristine VanAarsen
- London Health Sciences Centre, Division of Emergency Medicine, London, Ontario, Canada
| | | | - Justin Yan
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; St. Joseph's Healthcare London, London, Ontario, Canada
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Hu Sophia H, Fu Mei R, Liu S, Lin YK, Chang WY. CE: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes. Am J Nurs 2018; 118:24-32. [PMID: 29329117 PMCID: PMC5785420 DOI: 10.1097/01.naj.0000530221.87469.86] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
: Background: Although the benefits of aerobic exercise and strength training for patients with type 2 diabetes have been studied extensively, research on physical activity among Chinese American immigrants diagnosed with prediabetes or type 2 diabetes has been limited. PURPOSE We sought to learn more about this population's knowledge of physical activity, the types and intensity levels performed, and the barriers to such activity. DESIGN AND METHODS A concurrent mixed-methods design was used. The short version of the International Physical Activity Questionnaire-Chinese was used to quantitatively measure participants' levels of exercise intensity. Semistructured face-to-face interviews were conducted to obtain qualitative information regarding participants' knowledge about physical activity, the types performed, and the barriers to such activity. RESULTS A total of 100 Chinese American immigrants were recruited for the study from January to July 2012 in New York City. On average, participants had lived with a diagnosis of prediabetes or type 2 diabetes for 3.3 years and had lived in the United States for 21.5 years. Energy expenditure was measured in metabolic equivalent of task (MET) units; intensity was measured in cumulative MET-minutes per week. The mean total intensity score was 2,744 MET-minutes per week. This was achieved mainly through walking. The mean intensity score for walking was 1,454 MET-minutes per week; the mean duration was 79 minutes per day. Vigorous physical activity was least common. The mean intensity score for vigorous physical activity was 399 MET-minutes per week, and the mean duration was 17 minutes per week. Regarding types of physical activity, the most common were housekeeping, walking up stairs, and taking walking or stretching breaks every hour during the workday. Based on the interviews, three themes emerged regarding barriers to moderate or vigorous physical activity: insufficient education about physical activity, health concerns about physical activity, and work-related barriers to physical activity. CONCLUSIONS The majority of Chinese American immigrants with prediabetes or type 2 diabetes do not engage in sufficient physical activity, performing at a rate significantly below that of the general U.S. POPULATION Increases in the intensity and duration of physical activity should be promoted as part of diabetes management for Chinese American immigrants.
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Affiliation(s)
- H Hu Sophia
- Sophia H. Hu is an assistant professor and Wen-Yin Chang is a professor in the School of Nursing at Taipei Medical University, Taipei, Taiwan. Mei R. Fu is an associate professor in the Rory Meyers College of Nursing at New York University (NYU), New York City. Shan Liu is an associate professor in the College of Nursing and Public Health at Adelphi University, Garden City, NY. Yen-Kuang Lin is an associate research fellow in the Biostatistics Center at Taipei Medical University. This research was supported by grants from NYU's Muriel and Virginia Pless Center for Nursing Research, the Association of Chinese American Physicians, and the National Institute of Minority Health and Health Disparities (NIMHD project No. P60 MD000538-03). Contact author: Sophia H. Hu, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Okrainec K, Booth GL, Hollands S, Bell CM. Language Barriers Among the Foreign-Born in Canada: Agreement of Self-Reported Measures and Persistence Over Time. J Immigr Minor Health 2017; 19:50-56. [PMID: 26395900 DOI: 10.1007/s10903-015-0279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persistent language barriers are associated with poor health outcomes. The agreement between reporting a language barrier at time of immigration and in the 2007-2008 Canadian Community Health Survey (CCHS) was calculated using kappa scores among foreign-born individuals who arrived to Ontario, Canada between 1985 and 2005. A total of 2323 immigrants were included, with a mean (± SD) time of 10.2 ± 6.4 years between immigration and completing the CCHS. Only 6 % of immigrants reported a persistent language barrier, resulting in a low agreement between the two sources (kappa = 0.06, 95 % CI 0.042-0.086). Though immigrants were less likely to report a persistent language barrier the longer they had been in Canada, only 13 % of immigrants who had arrived <2 years ago reported one. Self-reported language barriers at time of immigration are poor indicators of persistent language barriers. There is a need for a better measure of language barriers among Canadian immigrants.
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Affiliation(s)
- Karen Okrainec
- Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8EW-432E, Toronto, ON, M5T 2S8, Canada. .,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada.
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
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Beig J, Khanolkar M, Cundy T. Type 2 diabetes in young adults in Central Auckland: demography and complications. Intern Med J 2017; 48:67-73. [PMID: 28967170 DOI: 10.1111/imj.13623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) in young adults is associated with a high risk of diabetes complications. AIMS To investigated the demography and the emergence of complications of young adults with T2D in the central Auckland region where there has been substantial immigration. METHODS In total, 310 young adults with T2D (<40 years) were registered with the Auckland Diabetes Centre in 2015. We documented demographic, anthropometric and metabolic variables and prevalence and the emergence of complications. RESULTS Three demographic groups accounted for 243 participants (78%): 135 (44%) were migrants of Asian or Pacific Island origin, diagnosed a median 9 years after migration at a mean age of 28 ± 6 years; 88 (29%) were New Zealand-born Pāsifika descent, with a high prevalence of morbid obesity and 37 (12%) had major mental illness or intellectual disability. At diagnosis, the median HbA1c was 80 mmol/mol, and in 28%, it was ≥100 mmol/mol. A median 6 years after diagnosis, 56% had some degree of retinopathy, with the prevalence related both to the duration of diabetes and glycaemic control (P = 0.001). Forty-four percent of subjects had abnormal albuminuria at diagnosis (12% with macroalbuminuria). Increased albuminuria was strongly associated with obesity (P = 0.002). The development of CKD stages 4-5 was related both to the severity of retinopathy and degree of albuminuria at diagnosis (P = 0.0001). Major cardiovascular events were related to the severity of retinopathy at diagnosis (P = 0.0001). CONCLUSIONS New migrants, New Zealand-born Pāsifika and patients with mental illness or an intellectual disability comprise the bulk of young onset T2D. The disease is aggressive, and by the age of 40, patients are already developing advanced complications.
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Affiliation(s)
- Junaid Beig
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Manish Khanolkar
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Tim Cundy
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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High incidence of type 1 diabetes in the immigrant population of Osona and Baix Camp. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2015.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Torrabías-Rodas M, Feliu-Rovira A, Porcar-Cardona I, Altimiras-Roset J. Alta incidencia de diabetes tipo 1 en población magrebí de Osona y Baix Camp. An Pediatr (Barc) 2017; 86:176-181. [DOI: 10.1016/j.anpedi.2015.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022] Open
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Söderström U, Samuelsson U, Åman J. National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment. Acta Paediatr 2016; 105:935-9. [PMID: 27144734 DOI: 10.1111/apa.13456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/11/2016] [Accepted: 04/29/2016] [Indexed: 12/16/2022]
Abstract
AIM This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents. METHODS This observational nationwide population-based cohort study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000 to 2010. Of the 13 415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n = 2627; with 10 control children missing probably due to the matching procedure). RESULTS Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or ketoacidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control. CONCLUSION Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes.
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Affiliation(s)
- Ulf Söderström
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
- Department of Pediatrics; Mälarsjukhuset Hospital; Eskilstuna Sweden
| | - Ulf Samuelsson
- Division of Paediatrics; Department of Molecular and Clinical Medicine; Linkoping University; Linköping Sweden
- Department of Pediatrics; The University Hospital in Linköping; Linköping Sweden
| | - Jan Åman
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
- Department of Pediatrics; Örebro University Hospital; Örebro Sweden
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Dirani M, Dang TM, Xie J, Gnanasekaran S, Nicolaou T, Rees G, Fenwick E, Lamoureux EL. Study methodology and diabetes control in patients from the non-English diabetes management project (NEDMP). Clin Exp Ophthalmol 2016; 45:160-167. [PMID: 27455413 DOI: 10.1111/ceo.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/23/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To describe the clinical characteristics of non-English speaking patients from the Diabetes Management Project (NEDMP), and compare their diabetes management and severity of diabetic retinopathy (DR) with the English-speaking DMP sample (EDMP). DESIGN A prospective study was conducted on non-English speaking adults with diabetes who attended the Royal Victorian Eye and Ear Hospital. PARTICIPANTS 136 (90.1%) non-English speaking adults were assessed, with a mean age of 72.2 years (range: 50-88 years); 74 (54.4%) were male. METHODS Participants completed interviewer-administered questionnaires and underwent visual acuity, fundus photography, optical coherence tomography, biochemistry and anthropometric measurements. The EDMP assessed 609 patients in 2009 using a similar protocol. MAIN OUTCOME MEASURES Type and duration of diabetes, diabetes control and diabetic retinopathy. RESULTS A total of 127 (93.4%) and 8 (5.9%) participants reported having type 2 and type 1 diabetes, respectively, with a median (IQR) duration of 17 (14) years. The proportion of patients with poor diabetes control (HbA1c ≥ 7%) in the NEDMP was similar to the EDMP (64.0% and 68.2%, respectively; P = 0.411). A significantly higher proportion of patients with DR in the NEDMP were found to have poor diabetes control (HbA1c ≥ 7%) compared to those without DR (80.9% vs. 50.0%, P = 0.003). Almost two-thirds of NEDMP patients (74/118) had DR and 23% (27/115) had diabetic macular edema. The prevalence of DR was similar between the NEDMP and EDMP studies, ranging from 25-30% and 28-29%. CONCLUSIONS The clinical characteristics, diabetes control, and DR severity of English and non-English-speaking patients were similar. The high proportion of poor diabetes management in non-English speaking patients with DR suggests educational and behavioural interventions to improve glycaemic control are warranted.
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Affiliation(s)
- Mohamed Dirani
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Trung M Dang
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Jing Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Sivashanth Gnanasekaran
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Theona Nicolaou
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Eva Fenwick
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, National University of Singapore and National University Health System, Singapore.,Duke-NUS Medical School, Singapore
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16
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Liu G, Chen XI, Zhou WU, Yang S, Ye S, Cao F, Liu YI, Xiong Y. Preparation of a novel composite nanofiber gel-encapsulated human placental extract through layer-by-layer self-assembly. Exp Ther Med 2016; 11:1447-1452. [PMID: 27073463 DOI: 10.3892/etm.2016.3084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/02/2015] [Indexed: 12/17/2022] Open
Abstract
Aqueous human placenta extract (HPE) has been previously used to treat chronic soft tissue ulcer; however, the optimal dosage of HPE has yet to be elucidated. The present study investigated a novel nanofiber gel composed through layer-by-layer (LbL) self-assembly, in which HPE was encapsulated. IKVAV, RGD, RAD16 and FGL-PA were screened and combined to produce an optimal vehicle nanofiber gel through LbL assembly. Subsequently, the aqueous HPE was encapsulated into this nanofiber at the appropriate concentration, and the morphology, particle size, drug loading efficacy, encapsulation rate, release efficiency and structure validation were detected. The encapsulation efficiency of all three HPE samples was >90%, the nanofiber gel exhibited a slow releasing profile, and the structure of HPE encapsulated in the nanofiber gel was unvaried. In conclusion, this type of novel composite nanocapsules may offer a promising delivery system for HPE.
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Affiliation(s)
- Guohui Liu
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - X I Chen
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - W U Zhou
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shuhua Yang
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shunan Ye
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Faqi Cao
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Y I Liu
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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17
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Wilhelm AK, Jacobson DJ, Guzman-Corrales L, Fan C, Baker K, Njeru JW, Wieland ML, Boehm DH. Regional Variation in Diabetic Outcomes by Country-of-Origin and Language in an Urban Safety Net Hospital. J Community Health 2016; 41:798-804. [PMID: 26841899 DOI: 10.1007/s10900-016-0155-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to diabetic care guidelines among US immigrants remains low. This study assesses adherence to diabetic care guidelines by country-of-origin and language among a limited English-proficient (LEP) population. Timely completion of diabetic measures and acceptable levels of hemoglobin A1c (A1c), low density lipoprotein (LDL) cholesterol, and blood pressure (BP) were compared between LEP and English-proficient (EP) patients in this 2013 retrospective cohort study of adult diabetics. More LEP patients met BP targets (83 vs. 68 %, p < 0.0001) and obtained LDL targets (89 vs. 85 %, p = 0.0007); however, they had worse LDL control (57 vs. 62 %, p = 0.0011). Ethiopians and Somalians [adjusted OR (95 % CI) = 0.44 (0.30, 0.63)] were less likely than Latin Americans to meet BP goals. LEP patients outperformed EP peers on several diabetic outcomes measures with important variation between groups. These data highlight the success of a safety net hospital in improving diabetes management among diverse populations.
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Affiliation(s)
- April K Wilhelm
- United Family Medicine Residency Program, Saint Paul, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Guzman-Corrales
- Minneapolis Medical Research Foundation, 701 Park Avenue South (P7), Minneapolis, MN, 55415, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Karen Baker
- Analytic Center of Excellence, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, 701 Park Avenue South (P7), Minneapolis, MN, 55415, USA
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18
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Haroon NN, Austin PC, Shah BR, Wu J, Gill SS, Booth GL. Risk of dementia in seniors with newly diagnosed diabetes: a population-based study. Diabetes Care 2015. [PMID: 26216873 DOI: 10.2337/dc15-0491] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study whether diabetes onset in late life is a risk factor for dementia. RESEARCH DESIGN AND METHODS We conducted a population-based matched cohort study using provincial health data from Ontario, Canada. Seniors with (n = 225,045) and without newly diagnosed diabetes (n = 668,070) between April 1995 and March 2007 were followed until March 2012 for a new diagnosis of dementia. Cox proportional hazards modeling was used to compare the risk of dementia between groups after adjusting for baseline cardiovascular disease, chronic kidney disease (CKD), hypertension, and other risk factors. RESULTS Over this period, we observed 169,114 new cases of dementia. Individuals with diabetes had a modestly higher incidence of dementia (2.68 vs. 2.62 per 100 person-years) than those without diabetes. In the fully adjusted Cox model, the risk of dementia was 16% higher among our subgroup with diabetes (hazard ratio [HR] 1.16 [95% CI 1.15-1.18]). Adjusted HRs for dementia were 1.20 (95% CI 1.17-1.22) and 1.14 (95% CI 1.12-1.16) among men and women, respectively. Among seniors with diabetes, the risk of dementia was greatest in those with prior cerebrovascular disease (HR 2.03; 95% CI 1.88-2.19), peripheral vascular disease (HR 1.47; 95% CI 1.19-1.82), and CKD (HR 1.44; 95% CI 1.38-1.51), and those with one or more hospital visits for hypoglycemia (HR 1.73; 95% CI 1.62-1.84). CONCLUSIONS In this population-based study, newly diagnosed diabetes was associated with a 16% increase in the risk of dementia among seniors. Preexisting vascular disease and severe hypoglycemia were the greatest risk factors for dementia in seniors with diabetes.
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Affiliation(s)
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Jianbao Wu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada Department of Medicine, Queen's University, Kingston, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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19
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Scheuing N, Wiegand S, Bächle C, Fröhlich-Reiterer E, Hahn E, Icks A, Ludwig KH, Mönkemöller K, Razum O, Rosenbauer J, Holl RW. Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry. PLoS One 2015; 10:e0135178. [PMID: 26295472 PMCID: PMC4546611 DOI: 10.1371/journal.pone.0135178] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/18/2015] [Indexed: 12/13/2022] Open
Abstract
Objective To study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome. Study Design and Methods 27,643 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother’s origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05. Results 83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant. Conclusion The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
- * E-mail:
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin, Berlin, Germany
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
| | | | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany
| | - Andrea Icks
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
- Department of Public Health, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Karl-Heinz Ludwig
- Clinic for Children and Adolescent Medicine, Mutterhaus der Borromäerinnen, Trier, Germany
| | | | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, German Center for Diabetes Research (DZD), Düsseldorf, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
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20
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The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years. J Clin Med 2015; 4:1207-16. [PMID: 26239554 PMCID: PMC4484995 DOI: 10.3390/jcm4061207] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/27/2015] [Accepted: 05/11/2015] [Indexed: 11/22/2022] Open
Abstract
Diabetes Mellitus (DM) is a growing worldwide epidemic. It was estimated that more than 366 million people would be affected. DM has spread its presence over the world due to lifestyle changes, increasing obesity and ethnicities, among others. Diabetic nephropathy (DN) is one of the most important DM complications. A changing concept has been introduced from the classical DN to diabetic chronic kidney disease (DCKD), taking into account that histological kidney lesions may vary from the nodular or diffuse glomerulosclerosis to tubulointerstitial and/or vascular lesions. Recent data showed how primary and secondary prevention were the key to reduce cardiovascular episodes and improve life expectancy in diabetic patients. A stabilization in the rate of end stage kidney disease has been observed in some countries, probably due to the increased awareness by primary care physicians about the prognostic importance of chronic kidney disease (CKD), better control of blood pressure and glycaemia and the implementation of protocols and clinical practice recommendations about the detection, prevention and treatment of CKD in a coordinated and multidisciplinary management of the DM patient. Early detection of DM and DCKD is crucial to reduce morbidity, mortality and the social and economic impact of DM burden in this population.
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Abstract
BACKGROUND AND PURPOSE Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes. METHODS This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient's preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates. RESULTS Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57-0.82; P<0.001). However, they were more likely to be discharged with a moderate-to-severe neurological deficit (65.9% versus 51.5%; OR, 1.25; 95% CI, 1.15-1.35). In-hospital complication rates did not differ, and quality of care indicators generally favored patients with language barriers. CONCLUSIONS Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics.
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Affiliation(s)
- Baiju R Shah
- From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.).
| | - Nadia A Khan
- From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.)
| | - Martin J O'Donnell
- From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.)
| | - Moira K Kapral
- From the Department of Medicine, University of Toronto, Ontario, Canada (B.R.S., M.K.K.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (B.R.S., M.K.K.); Department of Medicine, University of British Columbia, Vancouver, BC, Canada (N.A.K.); and Department of Medicine, National University of Ireland, Galway, Ireland (M.J.O.)
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Cefalu WT, Golden SH. Innovative approaches to understanding and addressing health disparities in diabetes care and research. Diabetes Care 2015; 38:186-8. [PMID: 25614688 PMCID: PMC5131866 DOI: 10.2337/dc14-2748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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