Diabetes subgroups and sociodemographic inequalities in Mexico: a cross-sectional analysis of nationally representative surveys from 2016 to 2022

Background

Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys.

Methods

We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage.

Findings

We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74).

Interpretation

Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states.

Funding

This research was supported by Instituto Nacional de Geriatría in Mexico.

The relationship between income, weight, and using traffic-light labeling to buy processed food in Ecuador

This paper presents an investigation of the factors influencing the decision to purchase processed food based on traffic-light labeling (TLL). To achieve this, we use data from the official National Survey of Health and Nutrition, which gathered information on 26,532 individuals aged between 19 and 59 between 2011 and 2013. Employing a probit regression to assess the likelihood of buying food based on TLL, we identify a positive association between income level and the probability of buying food based on TLL; indeed, our model suggests that a 1% increase in monthly income increases by 0.008 the probability of buying food based on TLL. We infer that people with higher levels of income are more aware of the benefits of TLL and healthy food habits. Our results also suggest that the probability of basing purchasing decisions on TLL is higher for overweight people compared to those of normal weight, that is, overweight people buy their processed food paying more attention to TLL compared to normal weight people.

Prediabetes as a risk factor for all-cause and cause-specific mortality: a prospective analysis of 115,919 adults without diabetes in Mexico City

BACKGROUND

Prediabetes has been associated with increased all-cause and cardiovascular mortality. However, no large-scale studies have been conducted in Mexico or Latin America examining these associations.

METHODS

We analyzed data from 115,919 adults without diabetes (diagnosed or undiagnosed) aged 35-84 years who participated in the Mexico City Prospective Study between 1998 and 2004. Participants were followed until January 1 st , 2021 for cause-specific mortality. We defined prediabetes according to the American Diabetes Association (ADA, HbA 1c 5.7% to 6.4%) and the International Expert Committee (IEC, HbA 1c 6.0-6.4%) definitions. Cox regression adjusted for confounders was used to estimate all-cause and cause-specific mortality rate ratios (RR) at ages 35-74 years associated with prediabetes.

FINDINGS

During 2,085,392 person-years of follow-up (median in survivors 19 years), there were 6,810 deaths at ages 35-74, including 1,742 from cardiovascular disease, 892 from renal disease and 108 from acute diabetic crises. Of 110,405 participants aged 35-74 years at recruitment, 28,852 (26%) had ADA-defined prediabetes and 7,203 (7%) had IEC-defined prediabetes. Compared with those without prediabetes, individuals with prediabetes had higher risk of all-cause mortality at ages 35-74 years (RR 1.13, 95% CI 1.07-1.19 for ADA-defined prediabetes and RR 1.28, 1.18-1.39 for IEC-defined prediabetes), as well as increased risk of cardiovascular mortality (RR 1.22 [1.10-1.35] and 1.42 [1.22-1.65], respectively), renal mortality (RR 1.35 [1.08-1.68] and 1.69 [1.24-2.31], respectively), and death from an acute diabetic crisis (RR 2.63 [1.76-3.94] and 3.43 [2.09-5.62], respectively). RRs were larger at younger than at older ages, and similar for men compared to women. The absolute excess risk associated with ADA and IEC-defined prediabetes at ages 35-74 accounted for6% and 3% of cardiovascular deaths respectively, 10% and 5% of renal deaths respectively, and 31% and 14% of acute diabetic deaths respectively.

INTERPRETATION

Prediabetes is a significant risk factor for all-cause, cardiovascular, renal, and acute diabetic deaths in Mexican adults. Identification and timely management of individuals with prediabetes for targeted risk reduction could contribute to reducing premature mortality from cardiometabolic causes in this population.

FUNDING

Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, UK Medical Research Council. Instituto Nacional de Geriatría (Mexico City).

RESEARCH IN CONTEXT

Evidence before this study: We conducted a literature search in PubMed to identify articles published in English before February 27 th , 2024 that reported on prospective studies examining the association between prediabetes with all-cause or cause-specific mortality or progression to diabetes in a Mexican or Latin American population, using the terms ("prediabetes" OR "impaired fasting glucose" OR "impaired glucose tolerance") AND ("mortality" OR "death") AND ("Mexico" OR "Mexican" OR "Latin America" OR "Latin American"). There were no studies examining risk associated with prediabetes definitions and mortality among adults in Mexico. We identified one study from Peru that included 988 participants and investigated only all-cause mortality for impaired fasting glucose and HbA 1c -based definitions of prediabetes from ADA and IEC; this study reported increased mortality risk related to ADA-defined prediabetes based on HbA 1c measures. Generalizability of these findings to other Latin American countries and regions with distinct cardiometabolic profiles in unclear. Added value of this study: Our study included 115,919 participants without diabetes from Mexico City, of whom (26%) had ADA-defined prediabetes and 7,203 (7%) had IEC-defined prediabetes. We found that prediabetes is associated with higher risks of all-cause and cause-specific mortality (cardiovascular, renal, and acute diabetic causes) than among participants without prediabetes. We found RRs to be larger at younger than at older ages, and largely similar for men compared to women. Among those without previously diagnosed diabetes, we found that the excess risk associated with ADA- and IEC-defined prediabetes at ages 35-74 years accounted for 6% and 3% of cardiovascular deaths, 10% and 5% of renal deaths, and 31% and 14% of acute diabetic deaths, respectively. .Implications of all the available evidence: Our results show that prediabetes is a significant risk factor for cardiovascular, kidney, and acute diabetic deaths among Mexican adults and accounts for a notable fraction of such deaths. Identification of individuals with prediabetes should be prioritized for optimized management to improve cardiometabolic outcomes in Mexican adults.

Insulin resistance potentiates the effect of remnant cholesterol on cardiovascular mortality in individuals without diabetes

BACKGROUND AND AIMS

Remnant cholesterol (RC) and insulin resistance (IR) have been independently associated with cardiovascular risk. Here, we evaluated the role of IR and RC on cardiovascular disease (CVD) mortality.

METHODS

We conducted an analysis of 16,113 individuals ≥20 years without diabetes from the National Health and Nutrition Examination Survey (NHANES-III/IV). RC levels were calculated using total cholesterol, non-HDL-c, and LDL-c; IR was defined as HOMA2-IR≥2.5 and CVD mortality as a composite of cardiovascular and cerebrovascular mortality. Multiple linear regression was used to assess the relationship between HOMA2-IR and RC and Cox regression models to assess their joint role in CVD mortality. Causally ordered mediation models were used to explore the mediating role of IR in RC-associated CVD mortality.

RESULTS

We identified an association between higher HOMA2-IR and higher RC levels. The effect of IR on CVD mortality was predominant (HR 1.32, 95%CI 1.18-1.48) and decreased at older ages (HR 0.934, 95%CI 0.918-0.959) compared to RC (HR 0.983, 95%CI 0.952-1.014). Higher risk of CVD mortality was observed in individuals with IR but normal RC (HR 1.37, 95%CI 1.25-1.50) and subjects with IR and high RC (HR 1.24, 95%CI 1.13-1.37), but not in subjects without IR but high RC. In mediation models, HOMA2-IR accounted for 78.2% (95%CI 28.11-98.89) of the effect of RC levels on CVD mortality.

CONCLUSIONS

Our findings suggest that RC potentiates the risk of CVD mortality through its effect on whole-body insulin sensitivity, particularly among younger individuals.

Exploring factors influencing domestic violence: a comprehensive study on intrafamily dynamics

Introduction

This econometric analysis investigates the nexus between household factors and domestic violence. By considering diverse variables encompassing mood, depression, health consciousness, social media engagement, household chores, density, and religious affiliation, the study aims to comprehend the underlying dynamics influencing domestic violence.

Methods

Employing econometric techniques, this study examined a range of household-related variables for their potential associations with levels of violence within households. Data on mood, depression, health consciousness, social media usage, household chores, density, and religious affiliation were collected and subjected to rigorous statistical analysis.

Results

The findings of this study unveil notable relationships between the aforementioned variables and levels of violence within households. Positive mood emerges as a mitigating factor, displaying a negative correlation with violence. Conversely, depression positively correlates with violence, indicating an elevated propensity for conflict. Increased health consciousness is linked with diminished violence, while engagement with social media demonstrates a moderating influence. Reduction in the time allocated to household chores corresponds with lower violence levels. Household density, however, exhibits a positive association with violence. The effects of religious affiliation on violence manifest diversely, contingent upon household position and gender.

Discussion

The outcomes of this research offer critical insights for policymakers and practitioners working on formulating strategies for preventing and intervening in instances of domestic violence. The findings emphasize the importance of considering various household factors when designing effective interventions. Strategies to bolster positive mood, alleviate depression, encourage health consciousness, and regulate social media use could potentially contribute to reducing domestic violence. Additionally, the nuanced role of religious affiliation underscores the need for tailored approaches based on household dynamics, positioning, and gender.

Prodromes and biological markers in schizophrenia: Importance for the dopamine, glutamate, and neurodevelopmental hypothesis

Background. Since schizophrenia is a multifactorial mental illness, a basic understanding of its etiological components improves its understanding, diagnosis, and the selection of therapeutic targets. Objective. To identify the prodromes and biological markers in schizophrenic or ultra-high risk (UHR) patients and elucidate their specificity. Method. Narrative review of relevant sources in English and Spanish in the Medline-PubMed database on minor physical abnormalities, cognitive abnormalities, neuroanatomical, and synaptic and cell changes present in schizophrenic patients and/or subjects with a high risk of developing schizophrenia Results. Patients with SZ and, to a lesser extent, UHR subjects present phenotypic and behavioral manifestations that correlate with underlying cell processes. The study of the latter makes it possible to characterize diagnostic biomarkers. At present, its clinical application is limited by factors such as poorly understood pathophysiology, lack of study models, homology with other psychiatric disorders, and the dearth of clinical trials conducted. Discussion and conclusion. Schizophrenia is the final manifestation of damage to prenatal and post-natal neurodevelopment and is reflected during the prodromal stage in early biological markers with clinical relevance. It is necessary to establish new study models that will increase knowledge to offer specific biomarkers for use in early clinical diagnosis.