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Oshima M, Iwata Y, Toyama T, Kitajima S, Hara A, Sakai N, Shimizu M, Furuichi K, Haneda M, Babazono T, Yokoyama H, Iseki K, Araki S, Ninomiya T, Hara S, Suzuki Y, Iwano M, Kusano E, Moriya T, Satoh H, Nakamura H, Makino H, Wada T. Sex differences in risk factors for end-stage kidney disease and death in type 2 diabetes: A retrospective cohort study. J Diabetes 2023; 15:246-254. [PMID: 36785912 PMCID: PMC10036257 DOI: 10.1111/1753-0407.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/27/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND This study investigated the sex differences in the risk of end-stage kidney disease (ESKD) and mortality, as well as the effect modification of sex on associated factors in patients with type 2 diabetes. METHODS This multicenter observational cohort study included 4328 patients with type 2 diabetes. Hazard ratios (HRs) with 95% confidence intervals (CIs) of sex for ESKD and death were estimated using Cox proportional regression with adjustment for baseline covariates. For assessing risk modification, HRs and incidence rates for ESKD and death were compared between sexes across patient characteristics using Cox proportional and Poisson regression models. RESULTS During a median follow-up of 7 years, 276 patients (70% men) developed ESKD, and 241 patients (68% men) died. Men had higher risks of ESKD (HR 1.34; 95% CI 1.02-1.75; p = .034) and death (HR 1.64; 95% CI 1.24-2.16; p = .001) versus women after adjusting for multiple covariates. Among patients with microalbuminuria, men had a substantially higher risk of ESKD versus women, compared to those with normo- and macroalbuminuria (p for interaction .04). Incidence rates were also increased in men versus women with albuminuria of around 300 mg/g. No differences were detected in the association of sex and death across baseline patient subgroups. CONCLUSIONS In type 2 diabetes, men had an increased risk of ESKD and death versus women. Moderately increased albuminuria was strongly associated with sex difference in developing ESKD.
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Affiliation(s)
- Megumi Oshima
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
- Innovative Clinical Research CenterKanazawa UniversityKanazawaJapan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
| | - Akinori Hara
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
- Department of Environmental and Preventive MedicineKanazawa UniversityKanazawaJapan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
| | - Miho Shimizu
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
| | - Kengo Furuichi
- Department of NephrologyKanazawa Medical UniversityUchinadaJapan
| | - Masakazu Haneda
- Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism, Department of Internal MedicineTokyo Women's Medical University School of MedicineTokyoJapan
| | | | | | - Shinichi Araki
- Division of Nephrology, Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public HealthGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Shigeko Hara
- Center of Health Management, Toranomon HospitalTokyoJapan
- Okinaka Memorial Institute for Medical ResearchTokyoJapan
| | - Yoshiki Suzuki
- Niigata University Medical and Dental HospitalNiigataJapan
| | - Masayuki Iwano
- Department of NephrologyFaculty of Medical Sciences, University of FukuiFukuiJapan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal MedicineJichi Medical UniversityTochigiJapan
| | | | - Hiroaki Satoh
- Department of Diabetes and EndocrinologyJuntendo University Urayasu HospitalChibaJapan
| | | | | | - Takashi Wada
- Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
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Zhang X, Yang Q, Zheng R, Zhao Z, Li M, Wang T, Xu M, Lu J, Wang S, Lin H, Wang W, Ning G, Bi Y, Xu Y, Chen Y. Sex differences in the risk of arterial stiffness among adults with different glycemic status and modifications by age. J Diabetes 2023; 15:121-132. [PMID: 36650122 PMCID: PMC9934959 DOI: 10.1111/1753-0407.13353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Studies indicate lower, comparable, and higher cardiovascular risks in women vs men in normal glucose regulation (NGR), prediabetes, and diabetes, respectively. However, this sex difference is uncertain and aging might play a part. We aimed to estimate sex differences in arterial stiffness in NGR, prediabetes, or diabetes and the potential modifications by age. METHODS We used baseline data of 9618 participants aged ≥40 years in a large community-based cohort study in Shanghai. Glycemic status was determined by history of diabetes, fasting and 2-h post-load glucose levels, and hemoglobin A1c levels. Arterial stiffness was examined by brachial-ankle pulse wave velocity (ba-PWV). Multivariable linear regression analysis was conducted to examine the associations between sex and ba-PWV levels in glycemic and age categories. RESULTS Before adjustment for age, women had lower, comparable, and higher ba-PWV vs men in the NGR, prediabetes, and diabetes groups, respectively. In participants aged 40-59 years, women were associated with lower ba-PWV levels in generally all glycemic strata after adjustment for age and other confounders. In participants aged ≥60 years, women were associated with significantly higher ba-PWV levels (β coefficient = 71.5; 95% confidence interval = 23.4, 119.7) and the sex difference was attenuated in the groups of prediabetes and diabetes with a borderline significant interaction between sex and glycemic status (p for interaction = .068). CONCLUSIONS The sex difference in cardiovascular risks in adults with NGR, prediabetes, or diabetes was dependent on age. Our findings provide new evidence for prioritizing preventive treatment against atherosclerosis in men vs women with different glycemic status.
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Affiliation(s)
- Xiaoyun Zhang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Qianqian Yang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Ruizhi Zheng
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Mian Li
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Min Xu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Hong Lin
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuhong Chen
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR ChinaShanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
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3
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Harb F, Bird CM, Webb EK, Torres L, deRoon-Cassini TA, Larson CL. Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation. Eur J Psychotraumatol 2023; 14:2211486. [PMID: 37229524 DOI: 10.1080/20008066.2023.2211486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Racial discrimination is a traumatic stressor that increases the risk for posttraumatic stress disorder (PTSD), but mechanisms to explain this relationship remain unclear. Peritraumatic dissociation, the complex process of disorientation, depersonalization, and derealization during a trauma, has been a consistent predictor of PTSD. Experiences of frequent racial discrimination may increase the propensity for peritraumatic dissociation in the context of new traumatic experiences and contribute to PTSD symptoms. However, the role of peritraumatic dissociation in the relationship between experiences of discrimination and PTSD has not been specifically explored.Objective: The current study investigated the role of peritraumatic dissociation in the impact of racial discrimination on PTSD symptoms after a traumatic injury, and the moderating role of gender.Method: One hundred and thirteen Black/African American individuals were recruited from the Emergency Department at a Level I Trauma Center. Two weeks after the trauma, participants self-reported their experiences with racial discrimination and peritraumatic dissociation. At the six-month follow-up appointment, individuals underwent a clinical assessment of their PTSD symptoms.Results: Results of longitudinal mediation analyses showed that peritraumatic dissociation significantly mediated the effect of racial discrimination on PTSD symptoms, after controlling for age and lifetime trauma exposure. A secondary analysis was conducted to examine the moderating role of gender. Gender was not a significant moderator in the model.Conclusions: Findings show that racial discrimination functions as a stressor that impacts how individuals respond to other traumatic events. The novel results suggest a mechanism that explains the relationship between racial discrimination and PTSD symptoms. These findings highlight the need for community spaces where Black Americans can process racial trauma and reduce the propensity to detach from daily, painful realities. Results also show that clinical intervention post-trauma must consider Black Americans' experiences with racial discrimination.
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Affiliation(s)
- Farah Harb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Claire M Bird
- Trauma Research Consortium, Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - E Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Goffnett J, Paceley MS, Fish JN, Saban P. Between cornfields and Kinfolk: Identity management among transgender youth in Midwestern families and communities. Fam Process 2022; 61:1681-1695. [PMID: 35137401 PMCID: PMC9357858 DOI: 10.1111/famp.12759] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Transgender and gender diverse (TGD) youth face high rates of discrimination and victimization in their communities and families that contribute to elevated rates of behavioral health concerns. While the individual links between community and family environments and well-being for this population are clear, how these environments work in unison remains unclear. Furthermore, the methods TGD youth use to manage their identities in these environments are not well understood. We address this gap by exploring the overlap between community climate and familial treatment of TGD identities and the methods TGD youth use to manage their identities in these environments. Semi-structured qualitative interviews were conducted with TGD youth (n = 19) in two Midwestern U.S. states. Thematic analysis was used to develop categories that represent the phenomena being investigated and to understand relationships between categories. Findings depict overlap about TGD people between three components of community climate and family members that shaped the treatment of TGD youth. Furthermore, community climate toward TGD people influenced identity management through the availability of proximal resources. Four methods of identity management emerged from the data: emotion work, educating, connections, and generativity. Findings are discussed in the context of current literature, and recommendations are made for future research and practice with TGD youth.
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Affiliation(s)
- Jacob Goffnett
- School of Social Work, University of Arkansas, Fayetteville, Arkansas, USA
| | - Megan S. Paceley
- School of Social Welfare, University of Kansas, Lawrence, Kansas, USA
| | - Jessica N. Fish
- Department of Family Science, University of Maryland, College Park, Maryland, USA
| | - Paul Saban
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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5
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Hwang W, Kim JH, Cheng KJ, Brown MT, Silverstein M. Reciprocal associations between affectual, associational, and normative solidarity with parents during children's early to established adulthood. Fam Process 2022; 61:1287-1304. [PMID: 34555863 PMCID: PMC10904150 DOI: 10.1111/famp.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Intergenerational solidarity has become increasingly important to understand, as close family members mobilize the provision of social support across generations and contribute to family wellbeing. However, less is known about continuity and change in normative (eldercare norms), affectual, and associational solidarity with mothers and fathers as children emerge into full or established adulthood. Therefore, we focused on reciprocal associations between three dimensions of intergenerational solidarity (normative, affectual, and associational) as reported by young-adult children from their early twenties to late thirties. Data were derived from respondents in the Longitudinal Study of Generations: daughters reported about relationships with 291 mother-father pairs and sons reported about relationships with 309 mother-father pairs in 2000, 2005, and 2016. Autoregressive cross-lagged models prospectively predicted mutual influences among the three dimensions of solidarity across daughter-parent and son-parent relationships. In addition, multiple group analysis was conducted to examine the children's gender difference. We found that normative solidarity and emotional closeness with mothers were mutually reinforcing in daughters' and sons' parental relationships. However, normative solidarity predicted emotional closeness with fathers in both daughter-parent and son-parent relationships. The study concludes that sons and daughters establish eldercare norms based on emotional components of solidarity with mothers, and suggest that filial duty is a key reason why mother-child relations become close over the family life course.
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Affiliation(s)
- Woosang Hwang
- Aging Studies Institute, Syracuse University, Syracuse, New York, USA
| | - Jeung Hyun Kim
- Department of Sociology, Syracuse University, Syracuse, New York, USA
| | - Kent Jason Cheng
- Department of Social Science, Syracuse University, Syracuse, New York, USA
| | - Maria T Brown
- School of Social Work and Aging Studies Institute, Syracuse University, Syracuse, New York, USA
| | - Merril Silverstein
- Department of Human Development and Family Science, Department of Sociology, and Aging Studies Institute, Syracuse University, Syracuse, New York, USA
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6
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Wilker S, Kolassa S, Ibrahim H, Rajan V, Pfeiffer A, Catani C, Kolassa IT. Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females. Eur J Psychotraumatol 2021; 12:1930702. [PMID: 34531962 PMCID: PMC8439243 DOI: 10.1080/20008198.2021.1930702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations. Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load. Method: In civilian post-conflict samples from Northern Uganda (N = 1665), Rwanda (N = 433), Syria (N = 974) and Sri Lanka (N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load. Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample. Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Stephan Kolassa
- SAP S/4HANA CIC & Q2C, SAP Switzerland AG, Tägerwilen, Switzerland
| | - Hawkar Ibrahim
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Vathsalan Rajan
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | | | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
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7
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Shen Y, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Yin P, Bazzano AN, Nigam S, Hu G. Race and sex differences in rates of diabetic complications. J Diabetes 2019; 11:449-456. [PMID: 30315628 PMCID: PMC6462252 DOI: 10.1111/1753-0407.12869] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies on racial differences in diabetic complications are very limited. The aim of this study was to investigate the race and sex differences in diabetic complications between African Americans and Whites with type 2 diabetes (T2D) in Louisiana. METHODS A prospective cohort study was performed of 27 113 African Americans and 40 431 Whites with T2D who were 35 to 95 years of age from three healthcare systems located in south Louisiana. Four major diabetic complications were assessed: coronary heart disease (CHD), heart failure, stroke, and end-stage renal disease (ESRD). RESULTS The age- and sex-adjusted incident rates per 1000 person-years and 95% confidence intervals (CI) for CHD, heart failure, stroke, and ESRD for African Americans with diabetes were 43.1 (95% CI 41.6-44.6), 36.6 (95% CI 35.2-37.9), 29.6 (95% CI 28.4-30.8), and 38.3 (95% CI 36.9-39.7), respectively. Cox regression models showed that African American women had a higher risk than White women for heart failure (hazard ratio (HR) 1.26; 95% CI 1.18-1.34), stroke (HR 1.15; 95% CI 1.08-1.22), and ESRD (HR 1.32; 95% CI 1.24-1.40), whereas African American men had higher risks than White men for heart failure (HR 1.33; 95% CI 1.25-1.43) and ESRD (HR 1.47; 95% CI 1.37-1.57) but a lower risk of CHD (HR 0.88; 95% CI 0.83-0.94). CONCLUSIONS The incidence of major diabetic complications varied among difference race and sex groups. More race- or sex-specific studies on complications in patients with diabetes are needed to see whether incident rates are changing over time.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Eboni G Price-Haywood
- Ochsner Health System Center for Applied Health Services Research, New Orleans, Louisiana, USA
| | - Ping Yin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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8
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MADSEN TE, KHOURY JC, ALWELL KA, MOOMAW CJ, DEMEL SL, FLAHERTY ML, WOO D, MACKEY J, DE LOS RIOS LA ROSA F, MARTINI S, FERIOLI S, ADEOYE O, KHATRI P, KISSELA BM, KLEINDORFER D. Sex differences in cardiovascular risk profiles of ischemic stroke patients with diabetes in the Greater Cincinnati/Northern Kentucky Stroke Study. J Diabetes 2018; 10:496-501. [PMID: 28523847 PMCID: PMC5694383 DOI: 10.1111/1753-0407.12567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the present study was to compare sex-specific associations between cardiovascular risk factors and diabetes mellitus (DM) among patients with acute ischemic stroke (AIS) in the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS). METHODS The GCNKSS ascertained AIS cases in 2005 and 2010 among adult (age ≥ 20 years) residents of a biracial population of 1.3 million. Past and current stroke risk factors were compared between those with and without DM using Chi-squared tests and multiple logistic regression analysis to examine sex-specific profiles. RESULTS There were 3515 patients with incident AIS; 1919 (55%) were female, 697 (20%) were Black, and 1146 (33%) had DM. Among both women and men with DM, significantly more were obese and had hypertension, high cholesterol, and coronary artery disease (CAD) compared with those without DM. For women with AIS, multivariable sex-specific adjusted analyses revealed that older age was associated with decreased odds of having DM (adjusted odds ratio [aOR] 0.88, 95% confidence interval [CI] 0.80-0.98). For women with CAD, the odds of DM were increased (aOR 1.76, 95% CI 1.33-2.32). Age and CAD were not significant factors in differentiating the profiles of men with and without DM. CONCLUSIONS Women with DM had strokes at a younger age, whereas no such age difference existed in men. Compared with men, women with DM were also more likely to have CAD than those without DM, suggesting a sex difference in the association between DM and vascular disease. These findings may suggest a need for more aggressive risk factor management in diabetic women.
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Affiliation(s)
- Tracy E. MADSEN
- Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI
- Corresponding Author: 55 Claverick Street, 2 floor, 401-489-5275, 401-444-6662,
| | - Jane C. KHOURY
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Daniel WOO
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Felipe DE LOS RIOS LA ROSA
- University of Cincinnati College of Medicine, Cincinnati, OH
- Baptist Health Neuroscience Center, Miami, FL
| | | | - Simona FERIOLI
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Opeolu ADEOYE
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pooja KHATRI
- University of Cincinnati College of Medicine, Cincinnati, OH
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