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Zhang Y, Li S, Cao Z, Cheng Y, Xu C, Yang H, Sun L, Jiao H, Wang J, Li WD, Wang Y. A network analysis framework of genetic and nongenetic risks for type 2 diabetes. Rev Endocr Metab Disord 2021; 22:461-469. [PMID: 32926312 DOI: 10.1007/s11154-020-09585-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/25/2022]
Abstract
Both genetic and nongenetic factors have been found to be associated with type 2 diabetes, however, the correlation between them is still unclear. In the present study, we aimed to fully decipher the nongenetic and genetic factor association network for type 2 diabetes. We identified risk factors for type 2 diabetes by systematically searching for related meta-analyses and genome-wide association studies (GWAS) database. Among a total of 27,822 studies screened, 202 articles were eligible, from which 174 nongenetic factors and 210 genetic factors associated with type 2 diabetes were identified. Then, we obtained 584 associations between the nongenetic and genetic factors of type 2 diabetes, based on which a risk factor association network was conducted. The nongenetic factors could be classified into seven categories according to the Global Burden of Diseases (GBD). Of these seven categories of nongenetic factors, five were found to be correlated with genes associated with type 2 diabetes, including environmental risks, behavioral risks, metabolic risks, related disease of type 2 diabetes, and treatments. Specifically, air pollutants of environmental risks, alcohol using of behavioral risks, obesity of metabolic risks, rheumatoid arthritis of related disease risk, and simvastatin of treatment was correlated with the largest number of genes. In summary, the correlation between genetic factors and nongenetic factors identified in this study indicates that there is a common phenotype-genotype association in type 2 diabetes, with the combinations of genotypes ("genetic signature") clustering in phenotypes related to type 2 diabetes. Thus, we should take a systematic approach to explore the relationship of various factors for type 2 diabetes, as well as other noncommunicable diseases.
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Affiliation(s)
- Yuan Zhang
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Yangyang Cheng
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Li Sun
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Hongxiao Jiao
- Department of Genetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Ju Wang
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Wei-Dong Li
- Department of Genetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Lozano-Esparza S, López-Ridaura R, Ortiz-Panozo E, González-Villalpando C, Aguilar-Salinas C, Hernández-Ávila JE, Hernández-Ávila M, Lajous M. Diabetes is associated with a higher risk of mortality among women in a middle-income country: Results form the Mexican Teacher's cohort study. DIABETES & METABOLISM 2019; 46:304-310. [PMID: 31525457 DOI: 10.1016/j.diabet.2019.101119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 01/09/2023]
Abstract
AIMS In Mexico City, the mortality rate among patients with diabetes appears to be four times that of people without diabetes. Our study aimed to refine analyses of the impact of diabetes on mortality in a large cohort of women from different areas in Mexico with healthcare insurance. METHODS Our study followed 111,299 women with comprehensive healthcare coverage from the Mexican Teachers' Cohort. After a median follow-up of 7.8years, 5514 (5%) prevalent self-reported diabetes cases and 4023 incident cases were identified, while deaths were identified through employers' databases and next-of-kin reports, with dates and causes of death for 1121 women obtained from mortality databases. Hazard ratios (HRs) for total and cause-specific mortality were estimated by Cox regression models, using follow-up time as the time scale and allowing for time-variable diabetes status after adjusting for age, socioeconomic status, use of health services, and anthropometric and lifestyle variables. RESULTS In multivariable-adjusted models, the HR for all-cause mortality was 3.28 (95% CI: 2.86-3.75) in women with vs. without diabetes. The impact of diabetes on mortality was higher in rural vs. urban areas (HR: 4.72 vs. 2.98, respectively). HRs were 1.57 and 23.44 for cancer and renal disease mortality, respectively. CONCLUSION In women with healthcare coverage in Mexico, the magnitude of the association between diabetes and all-cause mortality was higher than that observed in high-income countries, but less than what has previously been reported for Mexico. Such elevated mortality suggests a lack of adequate access to quality diabetes care in the population despite comprehensive healthcare coverage.
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Affiliation(s)
- S Lozano-Esparza
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - R López-Ridaura
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - E Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - C González-Villalpando
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - C Aguilar-Salinas
- Department of Endocrinology and Metabolism, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - J E Hernández-Ávila
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - M Hernández-Ávila
- Mexican Institute of Social Security (IMSS), Avenue Paseo de la Reforma 476, Juárez, 06600 Ciudad de México, CDMX, México
| | - M Lajous
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Arredondo A, Recaman AL. Determinants of Uncontrolled Hypertension in the Context of Universal Health Coverage in Middle-Income Countries. Am J Hypertens 2018; 31:1175-1177. [PMID: 30113624 DOI: 10.1093/ajh/hpy124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Armando Arredondo
- Health System Center, National Institute of Public Health, Cuernavaca, Mexico
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Arredondo A, Azar A, Recaman AL. Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico. Global Health 2018; 14:89. [PMID: 30143010 PMCID: PMC6109335 DOI: 10.1186/s12992-018-0404-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite more than 20 years of reform projects in health systems, the universal coverage strategy has not reached the expected results in most middle-income countries (MICs). Using evidence from the Mexican case on diabetes and hypertension as tracers of non-communicable diseases, the effective coverage rate barely surpasses half of the expected goals necessary to meet the challenges that these two diseases represent at the population level. Prevalence and incidence rates do not diminish either; they even grow. In terms of the economic burden, this means that lack of financial protection and catastrophic expense rates have increased, contrary to what could have been expected. DISCUSSION As any complex system, health systems present challenges and dilemmas that are difficult to solve. In terms of universal coverage, when contrasting normative coverage versus effective coverage, the epidemiological, cultural, organizational and economic challenges and barriers become evident. Such challenges have not allowed a greater effectiveness of the contributions of state of the art medicine in the resolution of health problems, particularly in relation to diabetes and hypertension. CONCLUSIONS Despite of the existence of many universal coverage projects, strategies and programs implemented in MICs, challenges remain and, far from disappearing, unresolved problems are still present, even with increasing trends. The model of care based on a curative biomedical approach was enough to respond to the health needs of the last century, but is no longer adapted to the needs of the present century. The dilemmas of continuity vs. rupture require to review and discuss the background and structure of health systems and their underlying models of care. These two elements have not allowed the different coverage schemes to guarantee greater effectiveness in the application of state of the art medicine, nor a greater health care financial protection for patients and their families. We thus can either accept the fragmented health systems and bio-medical-curative models of care approach or, instead, we can move towards integrated health systems that would be based on a socio-medical-preventive approach to health care.
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Affiliation(s)
- Armando Arredondo
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
| | - Alejandra Azar
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
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