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Nieuwenhuijse EA, van Hof TB, Numans ME, Struijs JN, Vos RC. Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases. Prim Care Diabetes 2023; 17:168-174. [PMID: 36658030 DOI: 10.1016/j.pcd.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
AIMS To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes. METHODS In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18-45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking. RESULTS Of 761 young adults (median age: 39 years (IQR 33-42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73-123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19-3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15-2.57). No associations were found with income. Being women was protective. CONCLUSION In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study.
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Affiliation(s)
- Emma A Nieuwenhuijse
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands.
| | - Teske B van Hof
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
| | - Jeroen N Struijs
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Rimke C Vos
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
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Ling S, Zaccardi F, Issa E, Davies MJ, Khunti K, Brown K. Inequalities in cancer mortality trends in people with type 2 diabetes: 20 year population-based study in England. Diabetologia 2023; 66:657-673. [PMID: 36690836 PMCID: PMC9947024 DOI: 10.1007/s00125-022-05854-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/15/2022] [Indexed: 01/25/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to describe the long-term trends in cancer mortality rates in people with type 2 diabetes based on subgroups defined by sociodemographic characteristics and risk factors. METHODS We defined a cohort of individuals aged ≥35 years who had newly diagnosed type 2 diabetes in the Clinical Practice Research Datalink between 1 January 1998 and 30 November 2018. We assessed trends in all-cause, all-cancer and cancer-specific mortality rates by age, gender, ethnicity, socioeconomic status, obesity and smoking status. We used Poisson regression to calculate age- and calendar year-specific mortality rates and Joinpoint regression to assess trends for each outcome. We estimated standardised mortality ratios comparing mortality rates in people with type 2 diabetes with those in the general population. RESULTS Among 137,804 individuals, during a median follow-up of 8.4 years, all-cause mortality rates decreased at all ages between 1998 and 2018; cancer mortality rates also decreased for 55- and 65-year-olds but increased for 75- and 85-year-olds, with average annual percentage changes (AAPCs) of -1.4% (95% CI -1.5, -1.3), -0.2% (-0.3, -0.1), 1.2% (0.8, 1.6) and 1.6% (1.5, 1.7), respectively. Higher AAPCs were observed in women than men (1.5% vs 0.5%), in the least deprived than the most deprived (1.5% vs 1.0%) and in people with morbid obesity than those with normal body weight (5.8% vs 0.7%), although all these stratified subgroups showed upward trends in cancer mortality rates. Increasing cancer mortality rates were also observed in people of White ethnicity and former/current smokers, but downward trends were observed in other ethnic groups and non-smokers. These results have led to persistent inequalities by gender and deprivation but widening disparities by smoking status. Constant upward trends in mortality rates were also observed for pancreatic, liver and lung cancer at all ages, colorectal cancer at most ages, breast cancer at younger ages, and prostate and endometrial cancer at older ages. Compared with the general population, people with type 2 diabetes had a more than 1.5-fold increased risk of colorectal, pancreatic, liver and endometrial cancer mortality during the whole study period. CONCLUSIONS/INTERPRETATION In contrast to the declines in all-cause mortality rates at all ages, the cancer burden has increased in older people with type 2 diabetes, especially for colorectal, pancreatic, liver and endometrial cancer. Tailored cancer prevention and early detection strategies are needed to address persistent inequalities in the older population, the most deprived and smokers.
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Affiliation(s)
- Suping Ling
- Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM), University of Leicester, Leicester, UK
| | - Eyad Issa
- Leicester HPB Unit, Leicester General Hospital, Leicester, UK
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM), University of Leicester, Leicester, UK
| | - Karen Brown
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, UK
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Lee HS, Park JC, Chung I, Liu J, Lee SS, Han K. Sustained Low Income, Income Changes, and Risk of All-Cause Mortality in Individuals With Type 2 Diabetes: A Nationwide Population-Based Cohort Study. Diabetes Care 2023; 46:92-100. [PMID: 36367896 DOI: 10.2337/dc21-2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 10/10/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is limited evidence on the association of sustained low-income status, income changes, and all-cause mortality risk in individuals with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Using the Korean Health Insurance Service database, we studied 1,923,854 adults with T2D (aged ≥30 years) without cardiovascular disease and cancer, who were enrolled from 2009 through 2012 and followed to the end of 2020 (median 10.8 years of follow-up). We defined income levels based on the amount of health insurance premiums and categorized them into quartiles, the first being the low-income group, and assessed the income status annually in the preceding 5 years. Cox proportional hazards models were used to quantify the association of low-income status and income changes with mortality, with adjustment for sociodemographic factors, comorbidities, and diabetes duration and treatment. RESULTS Participants who consecutively had low income showed a higher risk of mortality (hazard ratio [HR] 1.19; 95% CI 1.16-1.22), compared with those who had never been in the low-income group. This association was much stronger for consecutive recipients of Medical Aid, reflecting very-low-income status (HR 2.26; 95% CI 2.16-2.36), compared with those who had never been Medical Aid beneficiaries. Sustained low- and very-low-income status was associated with increased risk of mortality, specifically for younger adults (aged <40 years) and males. Those who experienced declines in income between the first (preceding 5 years) and the last (baseline) time points had an increased risk of mortality, regardless of baseline income status. CONCLUSIONS Among Korean adults with T2D, sustained low-income status and declines in income were associated with increased risk of mortality.
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Affiliation(s)
- Hong Seok Lee
- Department of Medicine, University of Arizona, Tucson, AZ
| | | | - Inkwan Chung
- Department of Information Sociology, Soongsil University, Seoul, South Korea
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Bucheon St. Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
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Wilson S, Calocer F, Rollot F, Fauvernier M, Remontet L, Tron L, Vukusic S, Le Page E, Debouverie M, Ciron J, Ruet A, De Sèze J, Zephir H, Moreau T, Lebrun-Frénay C, Laplaud DA, Clavelou P, Labauge P, Berger E, Pelletier J, Heinzlef O, Thouvenot E, Camdessanché JP, Leray E, Dejardin O, Defer G. Effects of socioeconomic status on excess mortality in patients with multiple sclerosis in France: A retrospective observational cohort study. Lancet Reg Health Eur 2023; 24:100542. [PMID: 36426377 PMCID: PMC9678948 DOI: 10.1016/j.lanepe.2022.100542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The effects of socio-economic status on mortality in patients with multiple sclerosis is not well known. The objective was to examine mortality due to multiple sclerosis according to socio-economic status. Methods A retrospective observational cohort design was used with recruitment from 18 French multiple sclerosis expert centers participating in the Observatoire Français de la Sclérose en Plaques. All patients lived in metropolitan France and had a definite or probable diagnosis of multiple sclerosis according to either Poser or McDonald criteria with an onset of disease between 1960 and 2015. Initial phenotype was either relapsing-onset or primary progressive onset. Vital status was updated on January 1st 2016. Socio-economic status was measured by an ecological index, the European Deprivation Index and was attributed to each patient according to their home address. Excess death rates were studied according to socio-economic status using additive excess hazard models with multidimensional penalised splines. The initial hypothesis was a potential socio-economic gradient in excess mortality. Findings A total of 34,169 multiple sclerosis patients were included (88% relapsing onset (n = 30,083), 12% progressive onset (n = 4086)), female/male sex ratio 2.7 for relapsing-onset and 1.3 for progressive-onset). Mean age at disease onset was 31.6 (SD = 9.8) for relapsing-onset and 42.7 (SD = 10.8) for progressive-onset. At the end of follow-up, 1849 patients had died (4.4% for relapsing-onset (n = 1311) and 13.2% for progressive-onset (n = 538)). A socio-economic gradient was found for relapsing-onset patients; more deprived patients had a greater excess death rate. At thirty years of disease duration and a year of onset of symptoms of 1980, survival probability difference (or deprivation gap) between less deprived relapsing-onset patients (EDI = −6) and more deprived relapsing-onset patients (EDI = 12) was 16.6% (95% confidence interval (CI) [10.3%–22.9%]) for men and 12.3% (95%CI [7.6%–17.0%]) for women. No clear socio-economic mortality gradient was found in progressive-onset patients. Interpretation Socio-economic status was associated with mortality due to multiple sclerosis in relapsing-onset patients. Improvements in overall care of more socio-economically deprived patients with multiple sclerosis could help reduce these socio-economic inequalities in multiple sclerosis-related mortality. Funding This study was funded by the ARSEP foundation “Fondation pour l'aide à la recherche sur la Sclérose en Plaques” (Grant Reference Number 1122). Data collection has been supported by a grant provided by the French State and handled by the “Agence Nationale de la Recherche,” within the framework of the “Investments for the Future” programme, under the reference ANR-10-COHO-002, Observatoire Français de la Sclérose en Plaques (OFSEP).
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Affiliation(s)
- Sarah Wilson
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
- Corresponding author. INSERM UMR 1086 “ANTICIPE”, University of Caen Normandy, Comprehensive Cancer Center Francois Baclesse, Avenue du General Harris, 14076 Caen Cedex 5, France.
| | - Floriane Calocer
- Department of Neurology, UNICAEN, Normandy University, MS Expert Center, CHU de Caen Normandy, Caen 14000, France
| | - Fabien Rollot
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon 69000, France
- Hospices Civils de Lyon, Hôpital Neurologique, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron 69500, France
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon 69000, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon 69000, France
- Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon 69000, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon 69000, France
- Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon 69000, France
| | - Laure Tron
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon 69000, France
- Hospices Civils de Lyon, Hôpital Neurologique, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron 69500, France
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon 69000, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | | | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Nancy, France
- Université de Lorraine, APEMAC, Nancy F-54000, France
| | - Jonathan Ciron
- Department of Neurology, CHU de Toulouse, CRC-SEP, Toulouse Cedex 9 F-31059, France
- Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, Toulouse Cedex 3 F-31024, France
| | - Aurélie Ruet
- Univ. Bordeaux, Bordeaux F-33000, France
- INSERM U1215, Neurocentre Magendie, Bordeaux F-33000, France
- Department of Neurology, CHU de Bordeaux, CIC Bordeaux CIC1401, Bordeaux F-33000, France
| | - Jérôme De Sèze
- Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, CIC 1434, INSERM 1434, Strasbourg F-67000, France
| | - Hélène Zephir
- CHU Lille, CRCSEP Lille, Univ Lille, U1172, Lille F-59000, France
| | - Thibault Moreau
- Department of Neurology, CHU de Dijon, EA4184, Dijon F-21000, France
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur2, Université Nice Côte d’Azur, Nice, France
| | - David-Axel Laplaud
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, CIC INSERM 1413, Service de Neurologie, Nantes F-44000, France
| | - Pierre Clavelou
- Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand F-63000, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand F-63000, France
| | - Pierre Labauge
- MS Unit, CHU de Montpellier, Montpellier Cedex 5 F-34295, France
- University of Montpellier (MUSE), Montpellier F-34000, France
| | - Eric Berger
- CHU de Besançon, Service de Neurologie 25 030, Besançon, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille 13005, France
| | - Olivier Heinzlef
- Departement of Neurology, Hôpital de Poissy, Poissy F-78300, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, Nimes Cedex 9 F-30029, France
- Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Univ. Montpellier, Montpellier Cedex 5 F-34094, France
| | | | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes F-35000, France
| | - Olivier Dejardin
- UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandy University, Caen 14000, France
| | - Gilles Defer
- Department of Neurology, UNICAEN, Normandy University, MS Expert Center, CHU de Caen Normandy, Caen 14000, France
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Peykari N, Saeedi Moghaddam S, Djalalinia S, Rezaei N, Mansouri A, Naderimagham S, Mehdipour P, Pazhuheian F, Khajavi A, Haghshenas R, Mahmoudi N, Mahmoudi Z, Dilmaghani-Marand A, Rezaee K, Larijani B, Khosravi A, Farzadfar F. Trends of Diabetes Mortality in Iran at National and Sub-National Levels from 1990 to 2015 and Its Association with Socioeconomic Factors. Med J Islam Repub Iran 2022; 36:172. [PMID: 36896241 PMCID: PMC9989979 DOI: 10.47176/mjiri.36.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 03/11/2023] Open
Abstract
Background: Following global commitments to prevent and control non-communicable diseases, we sought to estimate national and sub-national trends in diabetes mortality in Iran and assess its association with socioeconomic factors. Methods: In a systematic analytical study, to assess the correlation between diabetes mortality and socioeconomic factors, we used data obtained from the Death Registration System (DRS), the Spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015. Results: Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54), and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization yet declined with an increase in wealth and years of schooling as the main socio-economic factors. Conclusion: The rising trend of diabetes mortality rate at the national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the '25 by 25' goal.
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Affiliation(s)
- Niloofar Peykari
- Deputy for Education, Ministry of Health and Medical Education, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Nazila Rezaei
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anita Mansouri
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipour
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Pazhuheian
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Mahmoudi
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Mahmoudi
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Rezaee
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Khosravi
- Deputy for Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Farshad Farzadfar
- Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Wang J, Wild SH. Marked and widening socioeconomic inequalities in type 2 diabetes prevalence in Scotland. J Epidemiol Community Health 2021; 76:jech-2021-217747. [PMID: 34635549 DOI: 10.1136/jech-2021-217747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/02/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study investigated the association between socioeconomic status and type 2 diabetes (T2D) prevalence in Scotland in 2021 and tested the null hypothesis that inequalities had not changed since they were last described for 2001-2007. METHODS Data from a national population-based diabetes database for 35-to-84-year-olds in Scotland for 2021 and mid-year population estimates for 2019 stratified by sex and fifths of the Scottish Index of Multiple Deprivation were used to calculate age-specific prevalence of T2D. Age-standardised prevalence was estimated using the European Standard Population with relative risks (RRs) compared between the most (Q1) and least (Q5) deprived fifths for each sex, and compared against similar estimates from 2001 to 2007. RESULTS Complete data were available for 255 764 people (98.9%) with T2D. Age-standardised prevalence was lowest for women in Q5 (3.4%) and highest for men in Q1 (11.6%). RRs have increased from 2.00 (95% CI 1.52 to 2.62) in 2001-2007 to 2.48 (95% CI 2.43 to 2.53) in 2021 for women and from 1.58 (95% CI 1.20 to 2.07) in 2007 to 1.89 (95% CI 1.86 to 1.92) in 2021 for men. CONCLUSIONS Socioeconomic inequalities in T2D prevalence have widened between 2001-2007 and 2021. Further research is required to investigate potential medium-term effects of the COVID-19 pandemic.
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Affiliation(s)
- Jack Wang
- The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
- The University of Edinburgh Medical School, Edinburgh, UK
| | - Sarah H Wild
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Seng JJB, Monteiro AY, Kwan YH, Zainudin SB, Tan CS, Thumboo J, Low LL. Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review. BMC Med Res Methodol 2021; 21:49. [PMID: 33706717 PMCID: PMC7953703 DOI: 10.1186/s12874-021-01209-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients. Methods The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed. Results Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies. Conclusions Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01209-w.
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Affiliation(s)
- Jun Jie Benjamin Seng
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore
| | | | - Yu Heng Kwan
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Sueziani Binte Zainudin
- Department of General Medicine (Endocrinology), Sengkang General Hospital, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore. .,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore. .,Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. .,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore. .,Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168582, Singapore.
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Bak JCG, Serné EH, Kramer MHH, Nieuwdorp M, Verheugt CL. National diabetes registries: do they make a difference? Acta Diabetol 2021; 58:267-278. [PMID: 32770407 PMCID: PMC7907019 DOI: 10.1007/s00592-020-01576-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
AIMS The global epidemic of diabetes mellitus continues to expand, including its large impact on national health care. Measuring diabetes outcomes and their causes of variation highlights areas for improvement in care and efficiency gains; large registries carry this potential. By means of a systematic review, we aimed to give an overview of national registries worldwide by quantifying their data and assessing their influence on diabetes care. METHODS The literature on MEDLINE up to March 31, 2020, was searched, using keywords diabetes mellitus, national, registry, registration, and/or database. National disease-specific registries from corresponding articles were included. Database characteristics and clinical variables were obtained. All registries were compared to the ICHOM standard set of outcomes. RESULTS We identified 12 national clinical diabetes registries, comprising a total of 7,181,356 diabetic patients worldwide. Nearly all registries recorded weight, HbA1c, lipid profile, and insulin treatment; the recording of other variables varied to a great extent. Overall, registries corresponded fairly well with the ICHOM set. Most registries proved to monitor and improve the quality of diabetes care using guidelines as a benchmark. The effects on national healthcare policy were more variable and often less clear. CONCLUSIONS National diabetes registries confer clear insights into diagnostics, complications, and treatment. The extent to which registries influenced national healthcare policy was less clear. A globally implemented standard outcome set has the potential to improve concordance between national registries, enhance the comparison and exchange of diabetes outcomes, and allocate resources and interventions where most needed.
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Affiliation(s)
- Jessica C G Bak
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Li Y, Fei T, Wang J, Nicholas S, Li J, Xu L, Huang Y, Li H. Influencing Indicators and Spatial Variation of Diabetes Mellitus Prevalence in Shandong, China: A Framework for Using Data-Driven and Spatial Methods. GEOHEALTH 2021; 5:e2020GH000320. [PMID: 33778309 PMCID: PMC7989969 DOI: 10.1029/2020gh000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
To control and prevent the risk of diabetes, diabetes studies have identified the need to better understand and evaluate the associations between influencing indicators and the prevalence of diabetes. One constraint has been that influencing indicators have been selected mainly based on subjective judgment and tested using traditional statistical modeling methods. We proposed a framework new to diabetes studies using data-driven and spatial methods to identify the most significant influential determinants of diabetes automatically and estimated their relationships. We used data from diabetes mellitus patients' health insurance records in Shandong province, China, and collected influencing indicators of diabetes prevalence at the county level in the sociodemographic, economic, education, and geographical environment domains. We specified a framework to identify automatically the most influential determinants of diabetes, and then established the relationship between these selected influencing indicators and diabetes prevalence. Our autocorrelation results showed that the diabetes prevalence in 12 Shandong cities was significantly clustered (Moran's I = 0.328, p < 0.01). In total, 17 significant influencing indicators were selected by executing binary linear regressions and lasso regressions. The spatial error regressions in different subgroups were subject to different diabetes indicators. Some positive indicators existed significantly like per capita fruit production and other indicators correlated with diabetes prevalence negatively like the proportion of green space. Diabetes prevalence was mainly subjected to the joint effects of influencing indicators. This framework can help public health officials to inform the implementation of improved treatment and policies to attenuate diabetes diseases.
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Affiliation(s)
- Yizhuo Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Teng Fei
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Jian Wang
- Research Center of Health Economics and ManagementDong Fureng Institute of Economic and Social DevelopmentWuhan UniversityBeijingChina
| | - Stephen Nicholas
- Top Education InstituteSydneyNSWAustralia
- Newcastle Business SchoolUniversity of NewcastleNewcastleNSWAustralia
- School of Management and School of EconomicsTianjin Normal UniversityTianjinChina
| | - Jun Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Lizheng Xu
- School of Public HealthCenter for Health Economics Experiment and Public PolicyShandong UniversityKey Laboratory of Health Economics and Policy ResearchNHFPC (Shandong University)JinanChina
| | - Yanran Huang
- School of Public HealthCenter for Health Economics Experiment and Public PolicyShandong UniversityKey Laboratory of Health Economics and Policy ResearchNHFPC (Shandong University)JinanChina
| | - Hanqi Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
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Campbell RAS, Colhoun HM, Kennon B, McCrimmon RJ, Sattar N, McKnight J, Wild SH. Socio-economic status and mortality in people with type 1 diabetes in Scotland 2006-2015: a retrospective cohort study. Diabet Med 2020; 37:2081-2088. [PMID: 31967666 DOI: 10.1111/dme.14239] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/05/2023]
Abstract
AIMS To describe the association between socio-economic status and mortality in a nation-wide cohort of people with type 1 diabetes in Scotland and to compare patterns over time and with the general population. METHODS A retrospective cohort study was performed using data for people with type 1 diabetes from a population-based register linked to mortality records. Socio-economic status was derived from quintiles of an area-based measure: the Scottish Index of Multiple Deprivation. Sex-specific directly age-standardized mortality rates for each Scottish Index of Multiple Deprivation quintile and rate ratios comparing the most vs least deprived quintile were calculated for two time periods: 2006-2010 and 2011-2015. Data for the population without type 1 diabetes between 2011 and 2015 were available for comparison. RESULTS Data for 3802 deaths among 33 547 people with type 1 diabetes were available. The age-standardized mortality rate per 1000 person-years decreased over time (from 2006-2010 to 2011-2015) for men and women with type 1 diabetes: 24.8 to 20.2 and 22.5 to 17.6, respectively. Mortality in populations with and without type 1 diabetes was generally higher for men than women and was inversely associated with socio-economic status. Rate ratios for the most vs least deprived groups increased over time among people with type 1 diabetes (men: 2.49 to 2.81; women: 1.92 to 2.86) and were higher than among populations without type 1 diabetes in 2011-2015 (men: 2.06; women: 1.66). CONCLUSIONS Socio-economic deprivation was associated with a steeper mortality gradient in people with type 1 diabetes than in the population without type 1 diabetes in Scotland. Age-standardized mortality has decreased over time but socio-economic inequalities may be increasing.
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Affiliation(s)
| | - H M Colhoun
- MRC Institute of Genetic and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Department of Public Health, NHS Fife, Kirkcaldy, UK
| | - B Kennon
- Department of Diabetes, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S H Wild
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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11
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A national observation study of cancer incidence and mortality risks in type 2 diabetes compared to the background population over time. Sci Rep 2020; 10:17376. [PMID: 33060631 PMCID: PMC7566479 DOI: 10.1038/s41598-020-73668-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
We examined changing patterns in cancer incidence and deaths in diabetes compared to the background population. A total of 457,473 patients with type 2 diabetes, included between 1998 and 2014, were matched on age, sex, and county to five controls from the population. Incidence, trends in incidence and post-cancer mortality for cancer were estimated with Cox regression and standardised incidence rates. Causes of death were estimated using logistic regression. Relative importance of risk factors was estimated using Heller’s relative importance model. Type 2 diabetes had a higher risk for all cancer, HR 1.10 (95% CI 1.09–1.12), with highest HRs for liver (3.31), pancreas (2.19) and uterine cancer (1.78). There were lesser increases in risk for breast (1.05) and colorectal cancers (1.20). Type 2 diabetes patients experienced a higher HR 1.23 (1.21–1.25) of overall post-cancer mortality and mortality from prostate, breast, and colorectal cancers. By the year 2030 cancer could become the most common cause of death in type 2 diabetes. Persons with type 2 diabetes are at greater risk of developing cancer and lower chance of surviving it. Notably, hazards for specific cancers (e.g. liver, pancreas) in type 2 patients cannot be explained by obesity alone.
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12
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Carstensen B, Rønn PF, Jørgensen ME. Components of diabetes prevalence in Denmark 1996-2016 and future trends until 2030. BMJ Open Diabetes Res Care 2020; 8:8/1/e001064. [PMID: 32784246 PMCID: PMC7418686 DOI: 10.1136/bmjdrc-2019-001064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Incidence rates of diabetes have been increasing and mortality rates have been decreasing. Our aim is the quantification of the effects of these on the prevalence and prediction of the future burden of diabetes. RESEARCH DESIGN AND METHODS From population-based registers of Denmark, we derived diabetes incidence and mortality rates and mortality rates for persons without diabetes for the period 1996-2016. Rates were modeled by smooth parametric terms using Poisson regression. Estimated rates were used to assess the relative contribution of incidence and mortality to changes in prevalence over the study period as well as for prediction of future rates and prevalence 2017-2040. RESULTS The major contributors to prevalence was increasing incidence (22%) and epidemiological imbalance between incidence and mortality (27%). The decrease in mortality rates over the period 1996-2016 contributes only 9% of the prevalent cases at 2016. We estimated that 467 000 persons in Denmark would be living with diabetes in 2030. The age distribution of patients in the period 2017-2030 is predicted to change toward older ages. The total number of persons needing diabetes care will increase by 67% over the next 13 years, an average annual increase of 4.0%. CONCLUSIONS Lowering mortality among patients with diabetes even further is not likely to influence the prevalence substantially. Since the size and the increase in incidence of diabetes are major drivers of the increasing prevalence, the prevention of new cases of diabetes is required.
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Affiliation(s)
- Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Choi DW, Lee SA, Lee DW, Joo JH, Han KT, Kim S, Park EC. Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea. BMJ Open Diabetes Res Care 2020; 8:8/1/e000729. [PMID: 32611580 PMCID: PMC7332202 DOI: 10.1136/bmjdrc-2019-000729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study aimed to examine the effect of socioeconomic deprivation on the outcomes of diabetes complications in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We conducted a cohort study using claims data and 2005 national census data. We included of 7510 patients newly diagnosed with T2DM from 2004 to 2012 and aged 40 years or above. We excluded participants who had onset of diabetes complications and hospitalization within 1 year after initial onset T2DM, aged less than 40 years and with missing covariates. We used the regional socioeconomic deprivation index and classified study participants into five categories according to the quintile distribution. We calculated the adjusted HR and 95% CI for hospitalization related to diabetes complications and all-cause mortality by applying Cox proportional hazards model and the adjusted subdistribution hazards model. RESULTS The percentages of participants in the first quintile (least deprived) to fifth quintile (most deprived) were 27.0%, 27.9%, 19.5%, 14.8%, and 10.8% for socioeconomic deprivation; 25.4%, 28.8%, 32.4%, 34.6%, and 37.6% for hospitalization due to diabetes complications; 1.3%, 2.1%, 2.5%, 2.9%, and 3.6% for deaths from diabetes complications; and 5.7%, 7.2%, 9.7%, 9.7%, and 13.1% for deaths from all causes, respectively. Participants with higher socioeconomic deprivation had a higher HR for hospitalization and mortality from all-cause and diabetes complications. These associations were the strongest among men and participants in their 40s in hospitalization related to diabetes complications, 50s in diabetes complications-specific mortality and 50s and 60s in all-cause mortality. CONCLUSIONS Patients with T2DM with high socioeconomic deprivation had higher hospital admission and mortality rates for diabetes complications than those with low deprivation. We cannot fully explain the effect of socioeconomic deprivation on diabetes outcomes. Therefore, further studies are needed in order to find underlying mechanisms for these associations.
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Affiliation(s)
- Dong-Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea (the Republic of)
| | - Sang Ah Lee
- Research and Analysis Team, National Health Insurance Corporation Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
| | - Doo Woong Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea (the Republic of)
| | - Jae Hong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea (the Republic of)
| | - Kyu-Tae Han
- Division of Cancer Management Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea (the Republic of)
| | - SeungJu Kim
- Department of Nursing, Eulji University, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Eun-Cheol Park
- Department Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
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14
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Congdon P. A diabetes risk index for small areas in England. Health Place 2020; 63:102340. [PMID: 32543429 DOI: 10.1016/j.healthplace.2020.102340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 01/03/2023]
Abstract
UK and international studies point to significant area variation in diabetes risk, and summary indices of diabetic risk are potentially of value in effective targeting of health interventions and healthcare resources. This paper aims to develop a summary measure of the diabetic risk environment which can act as an index for targeting health care resources. The diabetes risk index is for 6791 English small areas (which provide entire coverage of England) and has advantages in incorporating evidence from both diabetes outcomes and area risk factors, and in including spatial correlation in its construction. The analysis underlying the risk index shows that area socio-economic status, social fragmentation and south Asian ethnic concentration are all positive risk factors for diabetes risk. However, urban-rural and regional differences in risk intersect with these socio-demographic influences.
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Affiliation(s)
- Peter Congdon
- School of Geography, Queen Mary University of London, Mile End Rd, London, E1 4NS, UK.
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15
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Saeedi P, Salpea P, Karuranga S, Petersohn I, Malanda B, Gregg EW, Unwin N, Wild SH, Williams R. Mortality attributable to diabetes in 20-79 years old adults, 2019 estimates: Results from the International Diabetes Federation Diabetes Atlas, 9 th edition. Diabetes Res Clin Pract 2020; 162:108086. [PMID: 32068099 DOI: 10.1016/j.diabres.2020.108086] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 02/08/2023]
Abstract
AIMS To estimate the number of deaths attributable to diabetes in 20-79-year-old adults in 2019. METHODS The following were used to estimate the number of deaths attributable to diabetes: all-cause mortality estimates from the World Health Organization life table, country level age- and sex-specific estimates of diabetes prevalence in 2019 and relative risks of death in people with diabetes compared to people without diabetes. RESULTS An estimated 4.2 million deaths among 20-79-year-old adults are attributable to diabetes. Diabetes is estimated to contribute to 11.3% of deaths globally, ranging from 6.8% (lowest) in the Africa Region to 16.2% (highest) in the Middle East and North Africa. About half (46.2%) of the deaths attributable to diabetes occur in people under the age of 60 years. The Africa Region has the highest (73.1%) proportion of deaths attributable to diabetes in people under the age of 60 years, while the Europe Region has the lowest (31.4%). CONCLUSIONS Diabetes is estimated to contribute to one in nine deaths among adults aged 20-79 years. Prevention of diabetes and its complications is essential, particularly in middle-income countries, where the current impact is estimated to be the largest. Contemporary data from diverse populations are needed to validate these estimates.
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Affiliation(s)
- Pouya Saeedi
- International Diabetes Federation, Brussels, Belgium.
| | | | | | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Edward W Gregg
- School of Public Health, Imperial College London, United Kingdom
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Sarah H Wild
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, United Kingdom
| | - Rhys Williams
- Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom
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Jacobs E, Tönnies T, Rathmann W, Brinks R, Hoyer A. Association between regional deprivation and type 2 diabetes incidence in Germany. BMJ Open Diabetes Res Care 2019; 7:e000857. [PMID: 31908802 PMCID: PMC6936410 DOI: 10.1136/bmjdrc-2019-000857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this analysis was to estimate the association between regional deprivation and type 2 diabetes incidence and to investigate differences by age and sex for Germany. Research design and methods Type 2 diabetes incidence rate ratios comparing the most deprived fifth of the population to the remainder of the population (divided into quintiles) were estimated using the illness-death model, which describes the relationship between prevalence, mortality, and incidence. For the analysis, we used the type 2 diabetes prevalence and the general mortality rate according to deprivation quintiles, which we calculated based on valid estimates for Germany. Because mortality rate ratios for people with type 2 diabetes compared with people without type 2 diabetes are lacking for Germany, we used estimates from Scotland. Estimates were standardized to the German population in 2012 and stratified by sex. Results Incidence of type 2 diabetes was estimated to be over twice as high among people living in the most deprived regions of Germany compared with people living in the least deprived regions (men: 2.41, 95% CI 1.27 to 4.28; women: 2.40, 95% CI 1.25 to 4.29). The strength of the association increased with increasing age until the age of 75 years. No sex differences were present. Conclusions The study adds new evidence regarding the association between type 2 diabetes incidence and regional deprivation for Germany. The results underpin the importance to intensify public health actions to reduce social inequalities in Germany and whole Europe in the future.
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Affiliation(s)
- Esther Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Hiller Research Unit for Rheumatology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annika Hoyer
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Salman A, Ukwaja KN, Alkhatib A. Factors Associated with Meeting Current Recommendation for Physical Activity in Scottish Adults with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203857. [PMID: 31614752 PMCID: PMC6843691 DOI: 10.3390/ijerph16203857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
It remains unclear which factors are instrumental in meeting the recommended physical activity in people with diabetes. We, therefore, aimed to determine the sociodemographic, health-related behavior and clinical factors associated with meeting the recommended levels of physical activity in Scottish adults with diabetes. The study was based on the nationally-representative cross-sectional Scottish Health Surveys (2014–2017). The study participants included a sub-sample of 1259 adults (≥16 years old) with diabetes. Physical activity was evaluated using international guidelines. Overall, 34.1% of the subjects met the recommended levels of physical activity. Independent determinants of meeting the recommended levels of physical activity include male gender (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.07–2.00) and being a non-smoker (OR 1.62; 95% CI 1.02–2.56). Furthermore, meeting the recommended physical activity levels decreased with age (OR 0.96; 95% CI 0.95–0.97), having a longstanding illness (OR 0.56; 95% CI 0.34–0.93) and body mass index (OR 0.94; 95% CI 0.92–0.97), but increased with higher fruit and vegetable intake (OR 1.16; 95% CI 1.07–1.25) and mental wellbeing (OR 1.04; 95% CI 1.02–1.06). Implementation of health promotion programs that target the identified determinants is needed to improve the recommended levels of physical activity among adults with diabetes.
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Affiliation(s)
- Ahmad Salman
- College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar.
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Kingsley Nnanna Ukwaja
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki PMB 102, Ebonyi State, Nigeria.
| | - Ahmad Alkhatib
- Institute of Sport Science, University of Taipei, Taipei 11153, Taiwan.
- School of Health and Social Care, Teesside University, Middlesbrough TS1 3BX, UK.
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Rodríguez-Sánchez B, Cantarero-Prieto D. Socioeconomic differences in the associations between diabetes and hospital admission and mortality among older adults in Europe. ECONOMICS AND HUMAN BIOLOGY 2019; 33:89-100. [PMID: 30771640 DOI: 10.1016/j.ehb.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
The aim of this study is to explain the trends in socioeconomic inequality and diabetes outcomes in terms of hospital admission and death in old European people. The sample includes 73,301 individuals, across 16 European countries taken from the Survey of Health, Ageing and Retirement in Europe (SHARE). People being diagnosed of diabetes were more likely to be admitted to hospital than those without diabetes, although its effect dropped after controlling for clinical and functional complications. Largest asscociations were observed in women, people aged 50-65 years old, with medium educational level and medium household income. Diabetes was significant and positively related to mortality in the whole sample. Diabetes is significantly associated with mortality risk especially in males, oldest old people, low education and medium income people. These findings have important implications for public policies to reduce socioeconomic-related health inequalities.
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Affiliation(s)
| | - David Cantarero-Prieto
- Department of Economics and GEN, University of Cantabria. Avenue. Los Castros, s/n, Santander, CP 39005, Spain.
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[Indices of Multiple Deprivation for the analysis of regional health disparities in Germany : Experiences from epidemiology and healthcare research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:1403-1412. [PMID: 29119206 DOI: 10.1007/s00103-017-2646-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Deprivation indices allow material and social differences at the regional level to be described in a statistically efficient and concise manner and to use these in health analyses. Following the British example, Indices of Multiple Deprivation (IMDs) are now available for Germany, the German Index of Multiple Deprivation (GIMD) as well as its regional versions. In this study, empirical experiences based on the use of these indices in health studies will be presented. METHOD The German IMDs consist of seven deprivation domains, which represent single aspects of deprivation (income, employment, and educational deprivation, municipal revenue deprivation, social capital deprivation, environment and security deprivation). Specific indicators were generated from data of official statistics and assigned to the deprivation domains. The weighted single domains were finally combined to an overall index. The German IMDs are available at a municipal level and at a district level. RESULTS Analyses using the IMDs showed significant associations between regional deprivation and mortality, morbidity and aspects of health services research. Multilevel analyses showed significant associations with regional deprivation, independent of individual factors. CONCLUSIONS The German IMDs are valid and efficient tools for the use in epidemiology and health services research, but also for health policy. When constructing deprivation indices, several methodological challenges have to be considered.
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keshavarzi F, Askarishahi M, Gholamniya Foumani M, Falahzadeh H. Parametric and the Cox risk model in the analysis of factors affecting the time of diagnosis of retinopathy with patients type 2 diabetes. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wu H, Lau ES, Kong AP, Ma RC, Ozaki R, Cheung KK, Chow E, Tsang CC, Lau KP, Hui EM, So WY, Gasevic D, Wild SH, Chan JC, Luk A. Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program. Clin Epidemiol 2018; 10:1561-1571. [PMID: 30464636 PMCID: PMC6208565 DOI: 10.2147/clep.s177437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to describe the association between educational level and incident cardiovascular disease (CVD) and all-cause mortality in Hong Kong Chinese patients with type 2 diabetes. Patients and methods We included 12,634 patients with type 2 diabetes who were enrolled into the Joint Asia Diabetes Evaluation Program between June 1, 2007, and June 30, 2017. We classified patients' educational level into the following three groups: ≤6 years, 6-13 years, and >13 years. Incident CVD events were identified using hospital discharge diagnoses. Death was identified from Hong Kong Death Register. We estimated HRs for incident CVD and all-cause mortality using Cox regression models. Results Patients with the highest educational level were younger and had shorter diabetes duration and better glycemic control at enrollment than those with the lowest educational level. During the median follow-up of 6.2 years for CVD and 6.4 years for all-cause mortality, 954 CVD events and 833 deaths were recorded. HRs for CVD and all-cause mortality were 0.73 (95% CI: 0.57, 0.94) and 0.71 (95% CI: 0.54, 0.94) for the highest educational level compared to the lowest educational level, after adjustment for age, sex, diabetes duration, and family history of diabetes. Conclusion Educational level is inversely associated with the risk of CVD and all-cause mortality among Hong Kong Chinese patients with type 2 diabetes. Hong Kong Chinese patients with type 2 diabetes and low educational level should be given special attention for the prevention of key complications of diabetes.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK, .,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China,
| | - Eric Sh Lau
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alice Ps Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ronald Cw Ma
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Kitty Kt Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Chiu Chi Tsang
- Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Kam Piu Lau
- Northern District Hospital, Fanling, Hong Kong SAR, China
| | - Eric Mt Hui
- Department of Family Medicine, Prince of Wales Hospital, Hong Kong SAR, China
| | - Wing Yee So
- Hospital Authority Head Office, Hong Kong SAR, China
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK, .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK,
| | - Juliana Cn Chan
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Andrea Luk
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China, .,Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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22
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Shin WY, Kim HC, Lee T, Jeon DH, Ha KH, Kim DJ, Chang HJ. Combined effects of diabetes and low household income on mortality: a 12-year follow-up study of 505 677 Korean adults. Diabet Med 2018; 35:1345-1354. [PMID: 29851428 DOI: 10.1111/dme.13695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/20/2022]
Abstract
AIM To examine the effects of diabetes, low income and their combination on mortality in the Korean population. METHODS We analysed a total of 505 677 people (53.9% male) aged 40-79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. RESULTS Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. CONCLUSION Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.
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Affiliation(s)
- W Y Shin
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - H C Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - T Lee
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - D-H Jeon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - K H Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - D J Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - H-J Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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23
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Hayashi S, Chandramohan D. Risk of active tuberculosis among people with diabetes mellitus: systematic review and meta-analysis. Trop Med Int Health 2018; 23:1058-1070. [PMID: 30062731 DOI: 10.1111/tmi.13133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the risk of active TB in people with DM and the factors associated with this risk. METHODS Systematic review and meta-analysis. We searched the literature for studies that reported the effect of DM on TB controlled for the effect of age. Studies that had not established the diagnosis of DM prior to detecting active TB were excluded. Study quality was assessed by Newcastle-Ottawa scale and we conducted a meta-analysis using random-effects models. RESULTS Of 14 studies (eight cohort and six case-control studies) that involved 22 616 623 participants met the selection criteria and were included in the analysis. There was substantial variation between studies in the estimates of the effect of DM on TB. However, the pooled estimates from seven high-quality studies showed that diabetic people have a 1.5-fold increased risk of developing active TB vs. those without DM (95%CI 1.28-1.76), with relatively small heterogeneity (I2 = 44%). The increased risk of TB was observed predominantly among DM populations with poor glycaemic control. CONCLUSION There is evidence suggesting an increased risk of developing TB among people with DM, and that improving glycaemic control in DM patients would reduce the risk of developing TB. An integrated approach is needed to control the dual burden of DM and TB.
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Affiliation(s)
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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24
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Huo L, Magliano DJ, Rancière F, Harding JL, Nanayakkara N, Shaw JE, Carstensen B. Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997-2011. Diabetologia 2018; 61:1055-1063. [PMID: 29473119 DOI: 10.1007/s00125-018-4544-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Current evidence suggests that type 2 diabetes may have a greater impact on those with earlier diagnosis (longer duration of disease), but data are limited. We examined the effect of age at diagnosis of type 2 diabetes on the risk of all-cause and cause-specific mortality over 15 years. METHODS The data of 743,709 Australians with type 2 diabetes who were registered on the National Diabetes Services Scheme (NDSS) between 1997 and 2011 were examined. Mortality data were derived by linking the NDSS to the National Death Index. All-cause mortality and mortality due to cardiovascular disease (CVD), cancer and all other causes were identified. Poisson regression was used to model mortality rates by sex, current age, age at diagnosis, diabetes duration and calendar time. RESULTS The median age at registration on the NDSS was 60.2 years (interquartile range [IQR] 50.9-69.5) and the median follow-up was 7.2 years (IQR 3.4-11.3). The median age at diagnosis was 58.6 years (IQR 49.4-67.9). A total of 115,363 deaths occurred during 7.20 million person-years of follow-up. During the first 1.8 years after diabetes diagnosis, rates of all-cause and cancer mortality declined and CVD mortality was constant. All mortality rates increased exponentially with age. An earlier diagnosis of type 2 diabetes (longer duration of disease) was associated with a higher risk of all-cause mortality, primarily driven by CVD mortality. A 10 year earlier diagnosis (equivalent to 10 years' longer duration of diabetes) was associated with a 1.2-1.3 times increased risk of all-cause mortality and about 1.6 times increased risk of CVD mortality. The effects were similar in men and women. For mortality due to cancer (all cancers and colorectal and lung cancers), we found that earlier diagnosis of type 2 diabetes was associated with lower mortality compared with diagnosis at an older age. CONCLUSIONS/INTERPRETATION Our findings suggest that younger-onset type 2 diabetes increases mortality risk, and that this is mainly through earlier CVD mortality. Efforts to delay the onset of type 2 diabetes might, therefore, reduce mortality.
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Affiliation(s)
- Lili Huo
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Fanny Rancière
- Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre, Villejuif, France
- Paris Descartes University, Sorbonne Paris Cité, UMR1153, Paris, France
| | - Jessica L Harding
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Natalie Nanayakkara
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
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25
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Walker J, Colhoun H, Livingstone S, McCrimmon R, Petrie J, Sattar N, Wild S. Type 2 diabetes, socioeconomic status and life expectancy in Scotland (2012-2014): a population-based observational study. Diabetologia 2018; 61:108-116. [PMID: 29075822 PMCID: PMC6448945 DOI: 10.1007/s00125-017-4478-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/18/2017] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the role of socioeconomic status (SES) in the associations between type 2 diabetes and life expectancy in a complete national population. METHODS An observational population-based cohort study was performed using the Scottish Care Information - Diabetes database. Age-specific life expectancy (stratified by SES) was calculated for all individuals with type 2 diabetes in the age range 40-89 during the period 2012-2014, and for the remaining population of Scotland aged 40-89 without type 2 diabetes. Differences in life expectancy between the two groups were calculated. RESULTS Results were based on 272,597 individuals with type 2 diabetes and 2.75 million people without type 2 diabetes (total for 2013, the middle calendar year of the study period). With the exception of deprived men aged 80-89, life expectancy in people with type 2 diabetes was significantly reduced (relative to the type 2 diabetes-free population) at all ages and levels of SES. Differences in life expectancy ranged from -5.5 years (95% CI -6.2, -4.8) for women aged 40-44 in the second most-deprived quintile of SES, to 0.1 years (95% CI -0.2, 0.4) for men aged 85-89 in the most-deprived quintile of SES. Observed life-expectancy deficits in those with type 2 diabetes were generally greater in women than in men. CONCLUSIONS/INTERPRETATION Type 2 diabetes is associated with reduced life expectancy at almost all ages and levels of SES. Elimination of life-expectancy deficits in individuals with type 2 diabetes will require prevention and management strategies targeted at all social strata (not just deprived groups).
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Affiliation(s)
- Jeremy Walker
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Helen Colhoun
- Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Shona Livingstone
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Rory McCrimmon
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
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26
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Zucker I, Shohat T, Dankner R, Chodick G. New onset diabetes in adulthood is associated with a substantial risk for mortality at all ages: a population based historical cohort study with a decade-long follow-up. Cardiovasc Diabetol 2017; 16:105. [PMID: 28810857 PMCID: PMC5558697 DOI: 10.1186/s12933-017-0583-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/29/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes has been reported to be associated with an increased relative risk for mortality, with estimates ranging from 1.1 to 2.1. Findings are inconsistent regarding modification of the risk by gender and by age. The aim of this study was to estimate the mortality risk associated with new-onset diabetes in adulthood, by age group and gender. METHODS From the database of a large health care provider, we identified 31,987 individuals diagnosed with diabetes during 2003-2005; and 162,656 individuals without diabetes, group-matched by age. We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for overall mortality adjusted for age, gender, socioeconomic (SE) level, obesity, smoking and comorbidities at baseline. RESULTS During a median follow-up of 9.5 years, 4464 (14%) of persons with diabetes and 13,327 (8.2%) of those without died. Among persons with incident diabetes, the proportion of men, smokers, obese and patients of low SE level was higher, as was the prevalence of cardiovascular disease and renal impairment at baseline. Incident diabetes was associated with an adjusted HR for mortality of 1.38 (95% CI 1.32-1.43). Mortality HR for DM was comparable with hypertension (1.42; 1.37-1.46), smoking (1.65; 1.58-1.71) and atherosclerosis (1.40; 1.35-1.46). Diabetes associated mortality HR was somewhat higher among women 1.78 (95% CI 1.58-2.08) as compared with men 1.51 (95% CI 1.41-1.62). CONCLUSIONS Incident diabetes in adults is associated with a substantial risk for mortality, especially in younger adults. Further efforts should be allocated to diabetes primary prevention.
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Affiliation(s)
- Inbar Zucker
- Israel Center for Disease Control (ICDC) Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tamy Shohat
- Israel Center for Disease Control (ICDC) Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rachel Dankner
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Gabriel Chodick
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
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Boulanger M, Al-Shahi Salman R, Kerssens J, Wild SH. Association between diabetes mellitus and incidence of intracerebral haemorrhage and case fatality rates: A retrospective population-based cohort study. Diabetes Obes Metab 2017; 19:1193-1197. [PMID: 28296194 DOI: 10.1111/dom.12934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 12/01/2022]
Abstract
We investigated the associations between diabetes (type 1, type 2 or no diabetes) and intracerebral haemorrhage (ICH) incidence as well as case fatality after ICH, in a retrospective cohort study of people aged 40 to 89 years in Scotland during the period 2004 to 2013, using linkage of population-based records of diagnosed diabetes, hospital discharges and deaths. We calculated ICH incidence and 30-day case fatality after hospital admission for ICH, along with their relative risks (RR) and 95% confidence intervals (CIs), among people with type 1 or type 2 diabetes compared to people without diabetes, adjusting for age, sex and socio-economic status (SES). There were 77, 1275 and 9778 incident ICH events and the case-fatality rate was 44% (95% CI 33, 57), 38% (95% CI 35, 41) and 36% (95% CI 35, 37) in people with type 1, type 2 and without diabetes, respectively. In comparison with absence of diabetes, type 1 diabetes was associated with a higher incidence of ICH (1.74, 95% CI 1.38-2.21) and higher case fatality after ICH (1.35, 95% CI 1.01-1.70), after adjustment for age, sex and SES. The small increases in ICH incidence (1.06, 95% CI 0.99-1.12) and case-fatality (1.04, 95% CI 0.96-1.13) in people with type 2 diabetes compared with people without diabetes were not statistically significant.
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Affiliation(s)
- Marion Boulanger
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Normandy University, UNICAEN, CHU Côte de Nacre, Neurology Service, Caen, France
| | | | - Jan Kerssens
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute for Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
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Wu H, Meng X, Wild SH, Gasevic D, Jackson CA. Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review. J Glob Health 2017; 7:011103. [PMID: 28702177 PMCID: PMC5481892 DOI: 10.7189/jogh.07.011103] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan. METHODS We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis. RESULTS Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age. CONCLUSIONS This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Xiangrui Meng
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Impact of Anxiety Disorders on Mortality for Persons With Diabetes: A National Population-Based Cohort Study. PSYCHOSOMATICS 2016; 58:266-273. [PMID: 28189286 DOI: 10.1016/j.psym.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most studies of the relationship between psychiatric disorders and mortality in patients with diabetes mellitus (DM) have focused on the role of depression. OBJECTIVE The aim of this study was to investigate the impact of anxiety disorders (ADs) on mortality in persons with DM in Taiwan. METHODS We used Taiwan׳s National Health Insurance claims database interlinked externally with Taiwan׳s Death Registry to study mortality in diabetic patients with and without ADs during the study period 2000-2004. Five-year survival cures were calculated using the Kaplan-Meier method for DM with ADs and DM without ADs. Cox regression analysis was used to analyze the predictive factors for DM mortality. RESULTS We identified 5685 persons with DM, including 732 (12.88%) who also had ADs. The 5-year survival was longer for diabetic patients with ADs than those without it. A higher risk of mortality was found in diabetic patients who were male. It was also higher for those who were 45-64 years old and ≥65 years old, those who resided in rural areas, those who had incomes <US$ 666 (NT$ 20,000) or were living on dependent incomes. ADs were found to confer a lower risk of mortality regardless of diabetes type. CONCLUSIONS ADs confer some protection from mortality in patients with DM. Our findings add valuable epidemiological information from a different ethnic population.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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30
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Read SH, Kerssens JJ, McAllister DA, Colhoun HM, Fischbacher CM, Lindsay RS, McCrimmon RJ, McKnight JA, Petrie JR, Sattar N, Wild SH. Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Diabetologia 2016; 59:2106-13. [PMID: 27465219 PMCID: PMC5016553 DOI: 10.1007/s00125-016-4054-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/24/2016] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS The relative contribution of increasing incidence and declining mortality to increasing prevalence of type 2 diabetes in Scotland is unclear. Trends in incidence and mortality rates are described for type 2 diabetes in Scotland between 2004 and 2013 by age, sex and socioeconomic deprivation. METHODS Data for incident and prevalent cases of type 2 diabetes were obtained from the Scottish national diabetes register with number of deaths identified from linkage to mortality records. Population size and death data for Scotland by age, sex and socioeconomic deprivation were obtained from National Records of Scotland. Age- and sex-specific incidence and mortality rates stratified by year and deciles of socioeconomic status were calculated using Poisson models. RESULTS There were 180,290 incident cases of type 2 diabetes in Scotland between 2004 and 2013. Overall, incidence of type 2 diabetes remained stable over time and was 4.88 (95% CI 4.84, 4.90) and 3.33 (3.28, 3.32) per 1000 in men and women, respectively. However, incidence increased among young men, remained stable in young women, and declined in older men and women. Incidence rates declined in all socioeconomic groups but increased after 2008 in the most deprived groups. Standardised mortality ratios associated with diabetes, adjusted for age and socioeconomic group, were 1.38 (1.36, 1.41) in men and 1.49 (1.45, 1.52) in women, and remained constant over time. CONCLUSIONS/INTERPRETATION Incidence of type 2 diabetes has stabilised in recent years suggesting that increasing prevalence may be primarily attributed to declining mortality. Prevention of type 2 diabetes remains important, particularly among socioeconomically deprived populations.
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Affiliation(s)
- Stephanie H Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Joannes J Kerssens
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - David A McAllister
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Colin M Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rory J McCrimmon
- Division of Cardiovascular & Diabetes Medicine, University of Dundee, Dundee, UK
| | | | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Abstract
There are an increasing number of clinical, administrative and trial databases that can be used for research. These are particularly valuable if there are opportunities for linkage to other databases. This paper describes examples of the use of large diabetes databases for research. It reviews the advantages and disadvantages of using large diabetes databases for research and suggests solutions for some challenges. Large, high-quality databases offer potential sources of information for research at relatively low cost. Fundamental issues for using databases for research are the completeness of capture of cases within the population and time period of interest and accuracy of the diagnosis of diabetes and outcomes of interest. The extent to which people included in the database are representative should be considered if the database is not population based and there is the intention to extrapolate findings to the wider diabetes population. Information on key variables such as date of diagnosis or duration of diabetes may not be available at all, may be inaccurate or may contain a large amount of missing data. Information on key confounding factors is rarely available for the nondiabetic or general population limiting comparisons with the population of people with diabetes. However comparisons that allow for differences in distribution of important demographic factors may be feasible using data for the whole population or a matched cohort study design. In summary, diabetes databases can be used to address important research questions. Understanding the strengths and limitations of this approach is crucial to interpret the findings appropriately.
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Affiliation(s)
- Sarah Wild
- Usher institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Colin Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - John McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, UK
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Nishtala PS, Salahudeen MS. Temporal trends in the use of antidiabetic medicines: a nationwide 9-year study in older people living in New Zealand. Ther Adv Drug Saf 2016; 7:184-194. [PMID: 27695620 DOI: 10.1177/2042098616660948] [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] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The global burden of diabetes is increasing worldwide. The aim of the study was to investigate the trends in use of antidiabetic medicines among older New Zealanders between 2005 and 2013, and to perform a separate analysis by age, sex, ethnicity, district health board domicile and socioeconomic deprivation index. METHODS The study population included individuals' aged 65 years and older living in New Zealand (NZ) captured in the pharmaceutical collections. Repeated cross-sectional analysis of population-level dispensing data was conducted from 1 January 2005 to 31 December 2013. Linear regression model using a gamma link function was used to estimate prevalence ratios and trends between 2005 and 2013. The main outcome measure was the prevalence of antidiabetic medicines in older New Zealanders. RESULTS The prevalence of antidiabetic medicines in older New Zealanders increased by 17.6% between 2005 and 2013. Individuals in the 70-74 age group had the highest utilization of each of the classes of antidiabetic medicines and those aged ⩾85 had the lowest utilization. Among the antidiabetic class of medicines, utilization of sulfonylureas was highest and alpha-glucosidase inhibitors the least. The utilization of thiazolidinediones increased over the study period. In 2013, insulin isophane and insulin glargine were the most common insulin analogues used. Insulin use was high in those aged ⩾85 years across the entire study period. The utilization of metformin increased gradually throughout the study period (by 43.9% in 2013 compared with 2005). CONCLUSION This population-level study showed an increase in utilization of antidiabetic medicines in older people in NZ from 2005 to 2013; however, the increase does not seem to parallel the proportional increase in prevalence of diabetes for the study period. Improving access to newer antidiabetic medicines in line with emerging evidence should be a consideration for decision makers.
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Affiliation(s)
- Prasad S Nishtala
- School of Pharmacy, University of Otago, P O Box 56, Dunedin 9054, New Zealand
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Leppold C, Tsubokura M, Ozaki A, Nomura S, Shimada Y, Morita T, Ochi S, Tanimoto T, Kami M, Kanazawa Y, Oikawa T, Hill S. Sociodemographic patterning of long-term diabetes mellitus control following Japan's 3.11 triple disaster: a retrospective cohort study. BMJ Open 2016; 6:e011455. [PMID: 27388360 PMCID: PMC4947778 DOI: 10.1136/bmjopen-2016-011455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the sociodemographic patterning of changes in glycaemic control of patients with diabetes affected by the 2011 triple disaster in Japan (earthquake, tsunami and nuclear accident). METHODS A retrospective cohort study was undertaken with 404 patients with diabetes at a public hospital in Minamisoma City, Fukushima Prefecture. Glycated haemoglobin (HbA1c) levels were measured in 2010, 2011 and 2012 to capture changes in glycaemic control postdisaster. Age, sex, urban/rural residency, evacuation status and medication use were also assessed. RESULTS There was an overall deterioration in glycaemic control after the disaster, with the mean HbA1c rising from 6.77% in 2010 to 6.90% in 2012 (National Glycohemoglobin Standardization Program, NGSP). Rural residency was associated with a lower likelihood of deteriorating control (OR 0.34, 95% CI 0.13 to 0.84), compared with urban residency. Older age (OR 0.95, 95% CI 0.91 to 0.98) was also slightly protective against increased HbA1c. Evacuation and sex were not significant predictors. CONCLUSIONS Patients with diabetes who were affected by Japan's triple disaster experienced a deterioration in their glycaemic control following the disasters. The extent of this deterioration was mediated by sociodemographic factors, with rural residence and older age protective against the effects of the disaster on glycaemic control. These results may be indicative of underlying social determinants of health in rural Japan.
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Affiliation(s)
- Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma, Japan
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
| | - Sae Ochi
- Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Jyoban Hospital of Tokiwakai Group, Iwaki, Japan
| | | | - Yukio Kanazawa
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Tomoyoshi Oikawa
- Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Sarah Hill
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Kim NH, Kim TJ, Kim NH, Choi KM, Baik SH, Choi DS, Park Y, Kim SG. Relative and combined effects of socioeconomic status and diabetes on mortality: A nationwide cohort study. Medicine (Baltimore) 2016; 95:e4403. [PMID: 27472736 PMCID: PMC5265873 DOI: 10.1097/md.0000000000004403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk.From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects' income levels.During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80-2.36) was observed (P for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95-4.60) than in those ≥60 years of age.Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.
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Affiliation(s)
- Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
| | - Tae Joon Kim
- Department of Statistics, Korea University, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
| | - Dong Seop Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
| | - Yousung Park
- Department of Statistics, Korea University, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine
- Correspondence: Sin Gon Kim, Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea (e-mail: )
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35
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Wild SH, Morling JR, McAllister DA, Kerssens J, Fischbacher C, Parkes J, Roderick PJ, Sattar N, Byrne CD. Type 2 diabetes and risk of hospital admission or death for chronic liver diseases. J Hepatol 2016; 64:1358-64. [PMID: 26812073 DOI: 10.1016/j.jhep.2016.01.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/06/2016] [Accepted: 01/14/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND & AIMS The impact of type 2 diabetes (T2DM) on hospital admissions and deaths due to common chronic liver diseases (CLDs) is uncertain. Our aim was to investigate associations between T2DM and CLDs in a national retrospective cohort study and to investigate the role of sex and socio-economic status (SES). METHODS We used International Classification of Disease codes to identify incident alcoholic liver disease (ALD), autoimmune liver disease, haemochromatosis, hepatocellular carcinoma, non-alcoholic fatty liver disease (NAFLD) and viral liver disease from linked diabetes, hospital, cancer and death records for people of 40-89years of age in Scotland 2004-2013. We used quasi Poisson regression to estimate rate ratios (RR). RESULTS There were 6667 and 33624 first mentions of CLD in hospital, cancer and death records over ∼1.8 and 24million person-years in people with and without T2DM, respectively. The most common liver disease was ALD among people without diabetes and was NAFLD among people with T2DM. Age-adjusted RR for T2DM compared to the non-diabetic population (95% confidence intervals) varied between 1.27 (1.04-1.55) for autoimmune liver disease and 5.36 (4.41-6.51) for NAFLD. RRs were lower for men than women and for more compared to less deprived populations for both ALD and NAFLD. CONCLUSIONS T2DM is associated with increased risk of hospital admission or death for all common CLDs and the strength of the association varies by type of CLD, sex and SES. Increasing prevalence of T2DM is likely to result in increasing burden of all CLDs.
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Affiliation(s)
- Sarah H Wild
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK.
| | - Joanne R Morling
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - David A McAllister
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Jan Kerssens
- Information Services Division, National Health Service National Services Scotland, Edinburgh, UK
| | - Colin Fischbacher
- Information Services Division, National Health Service National Services Scotland, Edinburgh, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, UK
| | - Paul J Roderick
- Primary Care and Population Sciences, University of Southampton, UK
| | - Naveed Sattar
- British Heart Foundation Centre for Cardiovascular Science, University of Glasgow, UK
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, UK
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Duncan EAS, Fitzpatrick D. Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis. BMC Emerg Med 2016; 16:13. [PMID: 26893294 PMCID: PMC4757997 DOI: 10.1186/s12873-016-0078-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/14/2016] [Indexed: 11/20/2022] Open
Abstract
Background Hypoglycaemia is a common and potentially life threatening consequence of insulin and sulphonylurea treated Diabetes. Some severe hypoglycaemic events result in emergency ambulance attendance. Many of these patients are treated at home and do not require immediate transportation to an Emergency Department. However only 27-37 % of patients then follow up their care with a diabetes specialist. Consequently repeat severe hypoglycaemic events occur. Methods The intervention was implemented for 8 months, using a prospective cohort design with a historic control, in one Scottish Health Board in 2012. Data was collected using postal survey questionnaires to patients and ambulance clinicians, telephone survey follow-up questions to patients. Scottish Ambulance Service electronic records were linked with the SCI-Diabetes database of patient records to enable objective measurement of follow-up behaviour. Results Ambulance clinicians’ (n = 92) awareness of the intervention was high and both the prompt card and telephone call components of the intervention were delivered to most eligible patients. The intervention was perceived as highly acceptable to patients (n = 37), and very useful by both patients and ambulance clinicians. However, comparison of patient follow-up behaviours using linked-data (n = 205), suggest that the intervention was unsuccessful in improving rates of patients’ following up their care. Conclusions This study shows that the intervention is implementable, highly acceptable to patients, and considered very useful by both patients and ambulance clinicians. However, preliminary evidence of effectiveness is not encouraging. The study’s novel use of linking existing clinical data for outcome measurement exposed challenges in the feasibility of using this data for intervention development and evaluation. Future research should examine challenges to the successful testing and effectiveness of the intervention. Revisions are likely to be required, both to study design and the optimisation of the intervention’s content and components. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0078-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward A S Duncan
- Nursing, Midwifery & Allied Health Professions Research Unit, Scion House, University of Stirling FK9 4NF, Scotland, UK.
| | - David Fitzpatrick
- Clinical Research Paramedic (Scottish Ambulance Service), Nursing, Midwifery & Allied Health Professions Research Unit, Scion House, University of Stirling FK9 4NF, Scotland, UK
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Siegel M, Mielck A, Maier W. Individual Income, Area Deprivation, and Health: Do Income-Related Health Inequalities Vary by Small Area Deprivation? HEALTH ECONOMICS 2015; 24:1523-1530. [PMID: 25294413 DOI: 10.1002/hec.3102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/21/2014] [Accepted: 08/08/2014] [Indexed: 06/03/2023]
Abstract
This paper aims to explore potential associations between health inequalities related to socioeconomic deprivation at the individual and the small area level. We use German cross-sectional survey data for the years 2002 and 2006, and measure small area deprivation via the German Index of Multiple Deprivation. We test the differences between concentration indices of income-related and small area deprivation related inequalities in obesity, hypertension, and diabetes. Our results suggest that small area deprivation and individual income both yield inequalities in health favoring the better-off, where individual income-related inequalities are significantly more pronounced than those related to small area deprivation. We then apply a semiparametric extension of Wagstaff's corrected concentration index to explore how individual-level health inequalities vary with the degree of regional deprivation. We find that the concentration of obesity, hypertension, and diabetes among lower income groups also exists at the small area level. The degree of deprivation-specific income-related inequalities in the three health outcomes exhibits only little variations across different levels of multiple deprivation for both sexes.
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Affiliation(s)
- Martin Siegel
- Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Germany
| | - Andreas Mielck
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Magliano DJ, Cohen K, Harding JL, Shaw JE. Residential distance from major urban areas, diabetes and cardiovascular mortality in Australia. Diabetes Res Clin Pract 2015; 109:271-8. [PMID: 26055757 DOI: 10.1016/j.diabres.2015.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/07/2015] [Accepted: 05/03/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Living outside major urban centres is associated with increased mortality in the general population but whether having diabetes further impacts on the effects of living outside major urban centres is not known. This study explores the impact of residential location and diabetes on all-cause, ischemic heart disease (IHD) and stroke mortality in Australia. METHODS We included 1,101,053 individuals (all ages) with diabetes on the national diabetes register, between 2000 and 2010. Vital statistics were collected by linkage to the death registry. The Accessibility/Remoteness Index of Australia (ARIA+) was used to categorize residences into major urban, inner regional, outer regional and remote areas, according to distance from major service centres. Standardised mortality ratios (SMRs) by ARIA+ are reported. RESULTS During follow-up (median 6.7 years), there were 187,761 deaths (46,244 and 12,786 IHD and stroke deaths, respectively). Age-standardized all-cause, stroke and IHD mortality rates increased across ARIA+ categories in diabetes and in the general population. For all outcomes, similar patterns were observed in both sexes and diabetes type, although the rates were higher in males. For all-cause (both sexes, type 1 diabetes (T1DM) and type 2 diabetes (T2DM)), IHD mortality (T2DM only) and stroke mortality (T2DM only), SMRs varied across ARIA+ categories, showing a shallow U-shaped relationship, in which the lowest SMR was in the inner regional or outer regional areas, and the highest SMR in the major urban or remote areas. CONCLUSION The effect of diabetes on mortality varied only modestly by location, and the impact of diabetes was greatest in the major urban and remote areas, and least in the inner and outer regional areas.
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Affiliation(s)
- D J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia.
| | - K Cohen
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J L Harding
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
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Dalsgaard EM, Skriver MV, Sandbaek A, Vestergaard M. Socioeconomic position, type 2 diabetes and long-term risk of death. PLoS One 2015; 10:e0124829. [PMID: 25942435 PMCID: PMC4420496 DOI: 10.1371/journal.pone.0124829] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/19/2015] [Indexed: 11/19/2022] Open
Abstract
Background Both socioeconomic position (SEP) and type 2 diabetes have previously been found to be associated with mortality; however, little is known about the association between SEP, type 2 diabetes and long-term mortality when comorbidity is taken into account. Methods We conducted a population-based cohort study of all Danish citizens aged 40-69 years with no history of diabetes during 2001-2006 (N=2,330,206). The cohort was identified using nationwide registers, and it was followed for up to 11 years (mean follow-up was 9.5 years (SD: 2.6)). We estimated the age-standardised mortality rate (MR) and performed Poisson regression to estimate the mortality-rate-ratio (MRR) by educational level, income and cohabiting status among people with and without type 2 diabetes. Results We followed 2,330,206 people for 22,971,026 person-years at risk and identified 139,681 individuals with type 2 diabetes. In total, 195,661 people died during the study period; 19,959 of these had type 2 diabetes. The age-standardised MR increased with decreasing SEP both for people with and without diabetes. Type 2 diabetes and SEP both had a strong impact on the overall mortality; the combined effect of type 2 diabetes and SEP on mortality was additive rather than multiplicative. Compared to women without diabetes and in the highest income quintile, the MRR’s were 2.8 (95%CI 2.6, 3.0) higher for women with type 2 diabetes in the lowest income quintile, while diabetes alone increased the risk of mortality 2.0 (95%CI 1.9, 2.2) times and being in the lowest income quintile without diabetes 1.8 (95%CI 1.7,1.9) times after adjusting for comorbidity. For men, the MRR’s were 2.7 (95%CI 2.5,2.9), 1.9 (95%CI 1.8,2.0) and 1.8 (95%CI 1.8,1.9), respectively. Conclusion Both Type 2 diabetes and SEP were associated with the overall mortality. The relation between type 2 diabetes, SEP, and all-cause mortality was only partly explained by comorbidity.
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Affiliation(s)
- Else-Marie Dalsgaard
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
- * E-mail:
| | - Mette V. Skriver
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark
| | - Annelli Sandbaek
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
| | - Mogens Vestergaard
- Department of Public Health, Section for General Practice, Aarhus University, Denmark
- Department of Public Health, Section for General Practice and Research Unit for General Practice, Aarhus University, Denmark
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Chen PC, Tsai CY, Woung LC, Lee YC. Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach. Int J Equity Health 2015; 14:31. [PMID: 25889800 PMCID: PMC4377057 DOI: 10.1186/s12939-015-0160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Literature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan. METHODS This study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan's National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models. RESULTS A total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010-2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization. CONCLUSIONS Our results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.
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Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan. .,Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan.
| | - Ching-Yao Tsai
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, No.145, Zhengzhou Rd, Datong Dist, Taipei City, 103, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec. 2, Linong St, Beitou Dist, Taipei City, 112, Taiwan.
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Collier A, Ghosh S, Hair M, Waugh N. Impact of socioeconomic status and gender on glycaemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region. DIABETES & METABOLISM 2014; 41:145-51. [PMID: 25454092 DOI: 10.1016/j.diabet.2014.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS In this cross-sectional study, the aims were to investigate the association of the socioeconomic status and gender on the prevalence of type 1 and 2 diabetes, glycaemic control, cardiovascular risk factors plus the complications of diabetes in a population-based analysis in the county of Ayrshire and Arran, Scotland. METHODS Quality Outcome Framework data was obtained from General Practices in Ayrshire and Arran, Scotland (n=15,351 patients). RESULTS In type 1 diabetes, there was an increasing linear trend in HbA1c across deprivation levels (P<0.01). In type 1 diabetes, obesity in women (P<0.01) and increased non-fasting triglyceride levels in both men and women were associated with deprivation (P<0.05). In type 2 diabetes, there was a significant prevalence trend with deprivation for women (P<0.01) but not with glycaemic control (P=0.12). Smoking, ischaemic heart disease and neuropathy (P<0.01) were all associated with increasing deprivation with gender differences. In type 2 diabetes, reduced HDL cholesterol (P<0.01 both genders), and percentage of people on lipid lowering therapy (men P<0.05; women P<0.01) were associated with deprivation. Smoking, ischaemic heart disease, peripheral vascular disease and neuropathy plus foot ulcers (P<0.05) were all associated with increasing deprivation with gender differences. CONCLUSIONS Socioeconomic status and gender are associated with changes in glycaemic control and cardiovascular risk factors plus complication development in both type 1 and 2 diabetes. The mechanisms are unclear but follow-up of these patients should allow greater understanding.
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Affiliation(s)
- A Collier
- Department of General Medicine, The Ayr Hospital, NHS Ayrshire & Arran, KA6 6DX, United Kingdom.
| | - S Ghosh
- AMRI Institute of Diabetes and Hormonal Disorders, 38/1A Gariahat Road, 700029 Kolkata, India
| | - M Hair
- Statistics Consultant, NHS Ayrshire & Arran, KA6 6DX, United Kingdom
| | - N Waugh
- Health Sciences, Division of Health Sciences, Warwick Medical School, Coventry CV4 7AL, United Kingdom
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Docking R, Mackay A, Williams C, Lewsey J, Kinsella J, Booth M. Comorbidity and Intensive Care Outcome — A Multivariable Analysis. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Decisions regarding admission to intensive care are made considering both the physiological state of the patient and the burden of comorbidity. Despite many retrospective cohort studies looking at isolated comorbidities, there has been little work to study multiple comorbidities and their effect upon intensive care outcome. In this retrospective cohort analysis, detailed comorbidity and demographic data were gathered on 1,029 patients from the West of Scotland and matched to both unit and hospital mortality at 30 days. Logistic regression was performed to investigate the factors associated with death within 30 days at both hospital and unit level. Variables with a p-value <0.25 at the univariable level were considered in a multivariable model. Variable selection for the multivariable modelling was carried out using backward selection and then replicated using forward selection to check for model stability. A modelling tool was constructed for both unit and hospital mortality at 30 days. This modelling has shown significant odds ratios for hospital death for alcoholic liver disease (OR 4.83), age (1.03), rheumatological diseases (1.93) and functional exercise tolerance prior to admission (3.08). Results from this work may inform a national prospective study to validate the modelling tool on a wider population.
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Færch K, Carstensen B, Almdal TP, Jørgensen ME. Improved survival among patients with complicated type 2 diabetes in Denmark: a prospective study (2002-2010). J Clin Endocrinol Metab 2014; 99:E642-6. [PMID: 24483155 DOI: 10.1210/jc.2013-3210] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT It is unclear to what extent recent advances in diabetes care have reduced the excess mortality in patients with complicated type 2 diabetes. OBJECTIVE The aim of this study was to estimate time trends in mortality among patients with complicated type 2 diabetes at the Steno Diabetes Center relative to the general Danish background population. DESIGN, SETTING, AND STUDY PARTICIPANTS: We performed a longitudinal follow-up study from 2002 to 2010 of 5844 patients with type 2 diabetes at the Steno Diabetes Center, Denmark. All-cause and cause-specific mortality was identified from the national death register. MAIN OUTCOME MEASURES Poisson regression was used to model mortality rates by sex, age, age of diabetes onset, and calendar time. RESULTS A total of 1341 deaths occurred (802 men and 539 women) during 32,913 person-years of follow-up. Total mortality rates in the diabetes population decreased by 5.5% (95% confidence interval 2.9%-8.0%) per year in men and by 3.3% (0.0%-6.4%) per year in women. Among men but not women, this decline was significantly steeper than the decline in mortality in the Danish background population (men, -3.0% [-5.6% to -0.4%]; women, -1.4 [-4.6% to 2.0%]). The decline in overall mortality was explained by a decline in cardiovascular mortality for both men and women. CONCLUSION Overall and cardiovascular mortality have decreased during the last decade among Danish patients with complicated type 2 diabetes, and for men, the decline in mortality was more pronounced than in the general population.
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Maier W, Scheidt-Nave C, Holle R, Kroll LE, Lampert T, Du Y, Heidemann C, Mielck A. Area level deprivation is an independent determinant of prevalent type 2 diabetes and obesity at the national level in Germany. Results from the National Telephone Health Interview Surveys 'German Health Update' GEDA 2009 and 2010. PLoS One 2014; 9:e89661. [PMID: 24586945 PMCID: PMC3937320 DOI: 10.1371/journal.pone.0089661] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/21/2014] [Indexed: 12/25/2022] Open
Abstract
Objective There is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany. Methods We combined data from two consecutive waves of the national health interview survey ‘GEDA’ conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n = 33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥30 kg/m2). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2. Results Of all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05–1.55) for T2DM and OR 1.28 (95% CI: 1.10–1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02–1.41)], but not for T2DM. Conclusion Area level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.
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Affiliation(s)
- Werner Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- * E-mail:
| | | | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | | | - Yong Du
- Robert Koch Institute, Berlin, Germany
| | | | - Andreas Mielck
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, Herder C, Rathmann W. Diabetes in Europe: an update. Diabetes Res Clin Pract 2014; 103:206-17. [PMID: 24300019 DOI: 10.1016/j.diabres.2013.11.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is among the leading causes of death in the IDF Europe Region (EUR), continues to increase in prevalence with diabetic macro- and microvascular complications resulting in increased disability and enormous healthcare costs. In 2013, the number of people with diabetes is estimated to be 56 million in EUR with an overall estimated prevalence of 8.5%. However, estimates of diabetes prevalence in 2013 vary widely in the 56 diverse countries in EUR from 2.4% in Moldova to 14.9% in Turkey. Trends in diabetes prevalence also vary between countries with stable prevalence since 2002 for many countries but a doubling of diabetes prevalence in Turkey. For 2035, a further increase of nearly 10 million people with diabetes is projected for the EUR. Prevalence of type 1 has also increased over the past 20 years in EUR and there was estimated to be 129,350 cases in children aged 0-14 years in 2013. Registries provide valid information on incidence of type 1 diabetes with more complete data available for children than for adults. There are large differences in distribution of risk factors for diabetes at the population level in EUR. Modifiable risk factors such as obesity, physical inactivity, smoking behaviour (including secondhand smoking), environmental pollutants, psychosocial factors and socioeconomic deprivation could be tackled to reduce the incidence of type 2 diabetes in Europe. In addition, diabetes management is a major challenge to health services in the European countries. Improved networking practices of health professionals and other stakeholders in combination with empowerment of people with diabetes and continuous quality monitoring need to be further developed in Europe.
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Affiliation(s)
- T Tamayo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
| | - A M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Negandhi PH, Ghouri N, Colhoun HM, Fischbacher CM, Lindsay RS, McKnight JA, Petrie J, Philip S, Sattar N, Wild SH. Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland. PLoS One 2013; 8:e83292. [PMID: 24358273 PMCID: PMC3865180 DOI: 10.1371/journal.pone.0083292] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland Methods We used a 2008 extract from the population-based national electronic diabetes database of Scotland. The association between ethnicity with mean glycaemic control in type 2 diabetes mellitus was examined in a retrospective cohort study, including adjustment for a number of variables including age, sex, socioeconomic status, body mass index (BMI), prescribed treatment and duration of diabetes. Results Complete data for analyses were available for 56,333 White Scottish adults, 2,535 Pakistanis, 857 Indians, 427 Chinese and 223 African-Caribbeans. All other ethnic groups had significantly (p<0.05) greater proportions of people with suboptimal glycaemic control (HbA1c >58 mmol/mol, 7.5%) compared to the White Scottish group, despite generally younger mean age and lower BMI. Fully adjusted odds ratios for suboptimal glycaemic control were significantly higher among Pakistanis and Indians (1.85, 95% CI: 1.68–2.04, and 1.62,95% CI: 1.38–1.89) respectively. Conclusions Pakistanis and Indians with type 2 diabetes mellitus were more likely to have suboptimal glycaemic control than the white Scottish population. Further research on health services and self-management are needed to understand the association between ethnicity and glycaemic control to address ethnic disparities in glycaemic control.
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Affiliation(s)
- Preeti H. Negandhi
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- * E-mail:
| | - Helen M. Colhoun
- Biomedical Research Institute, Mackenzie Building, University of Dundee, Dundee, Scotland, United Kingdom
| | - Colin M. Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom
| | - Robert S. Lindsay
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - John A. McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sam Philip
- Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sarah H. Wild
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, Scotland, United Kingdom
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Taylor KS, Heneghan CJ, Farmer AJ, Fuller AM, Adler AI, Aronson JK, Stevens RJ. All-cause and cardiovascular mortality in middle-aged people with type 2 diabetes compared with people without diabetes in a large U.K. primary care database. Diabetes Care 2013; 36:2366-71. [PMID: 23435157 PMCID: PMC3714501 DOI: 10.2337/dc12-1513] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Middle-aged people with diabetes have been reported to have significantly higher risks of cardiovascular events than people without diabetes. However, recent falls in cardiovascular disease rates and more active management of risk factors may have abolished the increased risk. We aimed to provide an up-to-date assessment of the relative risks associated with type 2 diabetes of all-cause and cardiovascular mortality in middle-aged people in the U.K. RESEARCH DESIGN AND METHODS Using data from the General Practice Research Database, from 2004 to 2010, we conducted a cohort study of 87,098 people, 40-65 years of age at baseline, comparing 21,798 with type 2 diabetes and 65,300 without diabetes, matched on age, sex, and general practice. We produced hazard ratios (HRs) for mortality and compared rates of blood pressure testing, cholesterol monitoring, and use of aspirin, statins, and antihypertensive drugs. RESULTS People with type 2 diabetes, compared with people without diabetes, had a twofold increased risk of all-cause mortality (HR 2.07 [95% CI 1.95-2.20], adjusted for smoking) and a threefold increased risk of cardiovascular mortality (3.25 [2.87-3.68], adjusted for smoking). Women had a higher relative risk than men, and people <55 years of age had a higher relative risk than those >55 years of age. Monitoring and medication rates were higher in those with diabetes (all P < 0.001). CONCLUSIONS Despite efforts to manage risk factors, administer effective treatments, and develop new therapies, middle-aged people with type 2 diabetes remain at significantly increased risk of death.
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Affiliation(s)
- Kathryn S Taylor
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Abstract
The increasing prevalence of diabetes in combination with an aging population and increasing female longevity means that it is important to understand the effects of diabetes on women's health. Both type 1 and type 2 diabetes influence health outcomes throughout the life-course. This review article provides a summary of sex differences in diabetes epidemiology and covers specific aspects of the life-course in women including: the menarche, pregnancy and the menopause. It also discusses the associations with other conditions: cardiovascular disease, osteoporosis and cancer.
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Affiliation(s)
- Joanne R Morling
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Ayah R, Joshi MD, Wanjiru R, Njau EK, Otieno CF, Njeru EK, Mutai KK. A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya. BMC Public Health 2013; 13:371. [PMID: 23601475 PMCID: PMC3641964 DOI: 10.1186/1471-2458-13-371] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 04/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi's largest slum. METHODS We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment. RESULTS Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45-54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women.Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco. CONCLUSIONS This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.
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Affiliation(s)
- Richard Ayah
- School of Public Health, College of Health Sciences, University of Nairobi, P.O. BOX 19676–00202, KNH, Nairobi, Kenya
| | - Mark D Joshi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Rosemary Wanjiru
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Elijah K Njau
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - C Fredrick Otieno
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Erastus K Njeru
- School of Public Health, College of Health Sciences, University of Nairobi, P.O. BOX 19676–00202, KNH, Nairobi, Kenya
| | - Kenneth K Mutai
- University of Nairobi Partnership for Advanced Care and Treatment (PACT), Centre of Excellence, Nairobi, Kenya
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Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, Kluttig A, Völzke H, Schipf S, Moebus S, Bokhof B, Berger K, Mueller G, Rathmann W, Tamayo T, Mielck A. The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med 2013; 30:e78-86. [PMID: 23127142 DOI: 10.1111/dme.12062] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 09/28/2012] [Accepted: 10/31/2012] [Indexed: 01/09/2023]
Abstract
AIM Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio-economic status. METHODS We pooled cross-sectional data from five German population-based studies. The data set contained information on n = 11,688 study participants (men 50.1%) aged 45-74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio-economic status and regional deprivation, based on a new small-area deprivation measure, the German Index of Multiple Deprivation. RESULTS Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation [OR 1.88 (95% CI 1.16-3.04) in quintile 4 and OR 2.14 (95% CI 1.29-3.55) in quintile 5 compared with the least deprived quintile 1], even after controlling for individual socio-economic status. Focusing on individual socio-economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level [OR 1.46 (95% CI 1.24-1.71)] and for the lowest compared with the highest income group [OR 1.53 (95% CI 1.18-1.99)]. CONCLUSION Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio-economic status. The results of the present study could help to target public health measures in deprived regions.
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Affiliation(s)
- W Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
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