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Sivadas A, Sahana S, Jolly B, Bhoyar RC, Jain A, Sharma D, Imran M, Senthivel V, Divakar MK, Mishra A, Mukhopadhyay A, Gibson G, Narayan KV, Sivasubbu S, Scaria V, Kurpad AV. Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population. BMJ Open Diabetes Res Care 2024; 12:e003769. [PMID: 38471670 PMCID: PMC10936492 DOI: 10.1136/bmjdrc-2023-003769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Genetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related long-term complications. India's distinct genetic architecture and its exploding burden of type 2 diabetes warrants a population-specific survey of NIAD-associated pharmacogenetic (PGx) variants. The recent availability of large-scale whole genomes from the Indian population provides a unique opportunity to generate a population-specific map of NIAD-associated PGx variants. RESEARCH DESIGN AND METHODS We mined 1029 Indian whole genomes for PGx variants, drug-drug interaction (DDI) and drug-drug-gene interactions (DDGI) associated with 44 NIADs. Population-wise allele frequencies were estimated and compared using Fisher's exact test. RESULTS Overall, we found 76 known and 52 predicted deleterious common PGx variants associated with response to type 2 diabetes therapy among Indians. We report remarkable interethnic differences in the relative cumulative counts of decreased and increased response-associated alleles across NIAD classes. Indians and South Asians showed a significant excess of decreased metformin response-associated alleles compared with other global populations. Network analysis of shared PGx genes predicts high DDI risk during coadministration of NIADs with other metabolic disease drugs. We also predict an increased CYP2C19-mediated DDGI risk for CYP3A4/3A5-metabolized NIADs, saxagliptin, linagliptin and glyburide when coadministered with proton-pump inhibitors (PPIs). CONCLUSIONS Indians and South Asians have a distinct PGx profile for antidiabetes drugs, marked by an excess of poor treatment response-associated alleles for various NIAD classes. This suggests the possibility of a population-specific reduced drug response in atleast some NIADs. In addition, our findings provide an actionable resource for accelerating future diabetes PGx studies in Indians and South Asians and reconsidering NIAD dosing guidelines to ensure maximum efficacy and safety in the population.
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Affiliation(s)
- Ambily Sivadas
- St John's Research Institute, Bangalore, Karnataka, India
| | - S Sahana
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Bani Jolly
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhinav Jain
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Disha Sharma
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vigneshwar Senthivel
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anushree Mishra
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Greg Gibson
- Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Sridhar Sivasubbu
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vinod Scaria
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Varghese JS, Ghosh A, Stein A, Narayan KV, Patel S. The association of hypertension among married Indian couples: a nationally representative cross-sectional study. Res Sq 2024:rs.3.rs-3865512. [PMID: 38352475 PMCID: PMC10862969 DOI: 10.21203/rs.3.rs-3865512/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Mounting evidence demonstrates that intimate partners sharing risk factors have similar propensities for chronic conditions such as hypertension. The objective was to study whether spousal hypertension was associated with one's own hypertension status independent of known risk factors, and stratified by socio-demographic subgroups (age, sex, wealth quintile, caste endogamy). Data were from heterosexual married couples (n = 50,023, women: 18-49y, men: 21-54y) who participated in the National Family Health Survey-V (2019-21). Hypertension was defined as self-reported diagnosis of hypertension or average of three blood pressure measurements ≥ 140 systolic or 90 mmHg diastolic BP. Among married adults, the prevalence of hypertension among men (38.8 years [SD: 8.3]) and women (33.9 years [SD: 7.9]) were 29.1% [95%CI: 28.5-29.8] and 20.6% [95%CI: 20.0-21.1] respectively. The prevalence of hypertension among both partners was 8.4% [95%CI: 8.0-8.8]. Women and men were more likely to have hypertension if their spouses had the condition (husband with hypertension: PR = 1.37 [95%CI: 1.30-1.44]; wife with hypertension: PR = 1.32 [95%CI: 1.26-1.38]), after adjusting for known risk factors. Spouse's hypertension status was consistently associated with own status across all socio-demographic subgroups examined. These findings present opportunities to consider married couples as a unit in efforts to diagnose and treat hypertension.
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Yu EA, Jackman RP, Glesby MJ, Narayan KV. Bidirectionality between Cardiometabolic Diseases and COVID-19: Role of Humoral Immunity. Adv Nutr 2023; 14:1145-1158. [PMID: 37302794 PMCID: PMC10256583 DOI: 10.1016/j.advnut.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiometabolic diseases and abnormalities have recently emerged as independent risk factors of coronavirus disease 2019 (COVID-19) severity, including hospitalizations, invasive mechanical ventilation, and mortality. Determining whether and how this observation translates to more effective long-term pandemic mitigation strategies remains a challenge due to key research gaps. Specific pathways by which cardiometabolic pathophysiology affects humoral immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and vice versa, remain unclear. This review summarizes current evidence of the bidirectional influences between cardiometabolic diseases (diabetes, adiposity, hypertension, CVDs) and SARS-CoV-2 antibodies induced from infection and vaccination based on human studies. Ninety-two studies among >408,000 participants in 37 countries on 5 continents (Europe, Asia, Africa, and North and South America) were included in this review. Obesity was associated with higher neutralizing antibody titers following SARS-CoV-2 infection. Most studies conducted prior to vaccinations found positive or null associations between binding antibodies (levels, seropositivity) and diabetes; after vaccinations, antibody responses did not differ by diabetes. Hypertension and CVDs were not associated with SARS-CoV-2 antibodies. Findings underscore the importance of elucidating the extent that tailored recommendations for COVID-19 prevention, vaccination effectiveness, screening, and diagnoses among people with obesity could reduce disease burden caused by SARS-CoV-2.
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Affiliation(s)
- Elaine A Yu
- Vitalant Research Institute, San Francisco, CA; University of California, San Francisco, San Francisco, CA.
| | - Rachael P Jackman
- Vitalant Research Institute, San Francisco, CA; University of California, San Francisco, San Francisco, CA
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | - Km Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, GA; Emory Global Diabetes Research Center of Woodruff Health Sciences Center, Emory University, Atlanta, GA
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Varghese JS, Carrillo-Larco RM, Narayan KV. Achieving replicable subphenotypes of adult-onset diabetes. Lancet Diabetes Endocrinol 2023; 11:635-636. [PMID: 37536356 DOI: 10.1016/s2213-8587(23)00195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Jithin Sam Varghese
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Emory Global Diabetes Research Center of Emory University and Woodruff Health Sciences Center, Atlanta, GA, USA
| | - Km Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Emory Global Diabetes Research Center of Emory University and Woodruff Health Sciences Center, Atlanta, GA, USA
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Weber MB, Rhodes EC, Ranjani H, Jeemon P, Ali MK, Hennink MM, Anjana RM, Mohan V, Narayan KV, Prabhakaran D. Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial. Res Sq 2023:rs.3.rs-3143470. [PMID: 37577514 PMCID: PMC10418536 DOI: 10.21203/rs.3.rs-3143470/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Delivery of proven structured lifestyle change education for reducing the burden of cardiometabolic diseases such as diabetes at worksites could overcome barriers to program adoption and improve sustainability and reach of these programs; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at eleven large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. Results Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. Conclusion This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. Trial Registration Clinicaltrial.gov NCT02813668, registered June 27, 2016.
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Nielsen J, Shivashankar R, Cunningham SA, Prabhakaran D, Tandon N, Mohan V, Iqbal R, Narayan KV, Ali MK, Patel SA. Couple concordance in diabetes, hypertension and dyslipidaemia in urban India and Pakistan and associated socioeconomic and household characteristics and modifiable risk factors. J Epidemiol Community Health 2023; 77:336-342. [PMID: 36918271 DOI: 10.1136/jech-2022-219979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/18/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Concordance in chronic disease status has been observed within couples. In urban India and Pakistan, little is known about couple concordance in diabetes, hypertension, and dyslipidaemia and associated socioeconomic characteristics and modifiable risk factors. METHODS We analysed cross-sectional data from 2548 couples from the Centre for cArdio-metabolic Risk Reduction in South Asia cohort in Chennai, Delhi and Karachi. We estimated couple concordance in presence of ≥1 of diabetes, hypertension and dyslipidaemia (positive concordance: both spouses (W+H+); negative concordance: neither spouse (W-H-); discordant wife: only wife (W+H-); or discordant husband: only husband (W-H+)). We assessed associations of five socioeconomic and household characteristics, and six modifiable risk factors with couple concordance using multinomial logistic regression models with couples as the unit of analysis (reference: W-H-). RESULTS Of the couples, 59.4% (95% CI 57.4% to 61.3%) were concordant in chronic conditions (W+H+: 29.2% (95% CI 27.4% to 31.0%); W-H-: 30.2% (95% CI 28.4%- to 32.0%)); and 40.6% (95% CI 38.7% to 42.6%) discordant (W+H-: 13.1% (95% CI 11.8% to 14.4%); W-H+: 27.6% (95% CI 25.9% to 29.4%)). Compared with couples with no conditions (W-H-), couples had higher relative odds of both having at least one condition if they had higher versus lower levels of: income (OR 2.03 (95% CI 1.47 to 2.80)), wealth (OR 2.66 (95% CI 1.98 to 3.58)) and education (wives' education: OR 1.92 (95% CI 1.29 to 2.86); husbands' education: OR 2.98 (95% CI 1.92 to 4.66)) or weight status (overweight or obesity in both spouses ORs 7.17 (95% CI 4.99 to 10.30)). CONCLUSIONS Positive couple concordance in major chronic conditions is high in urban India and Pakistan, especially among couples with relatively higher socioeconomic position. This suggests that prevention and management focusing on couples at high risk for concordant chronic conditions may be effective and more so in higher socioeconomic groups.
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Affiliation(s)
- Jannie Nielsen
- Emory Global Diabetes Research Center, Hubert Department of GlobalHealth, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA .,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roopa Shivashankar
- Division of Non Communicable Diseases', Indian Council of Medical Research, New Delhi, India.,Centre for Chronic Disease Control, New Delhi, India
| | - Solveig A Cunningham
- Emory Global Diabetes Research Center, Hubert Department of GlobalHealth, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Research Division, Public Health Foundation of India, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, Metabolism & Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr.Mohan's Diabetes Specialities Centre, Chennai, Tamilnadu, India
| | - Romaina Iqbal
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Km Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of GlobalHealth, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Hubert Department of GlobalHealth, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Shivani Anil Patel
- Emory Global Diabetes Research Center, Hubert Department of GlobalHealth, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Nielsen J, Narayan KV, Cunningham SA. Incidence of obesity across adulthood in the United States, 2001-2017-a national prospective analysis. Am J Clin Nutr 2023; 117:141-148. [PMID: 36789933 PMCID: PMC10196588 DOI: 10.1016/j.ajcnut.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the United States, the prevalence of obesity among adults has increased 3-fold since the 1980s, but patterns of incidence of new cases of obesity are not known. OBJECTIVES To examine the incidence of new cases of obesity: overall, by demographic and educational subgroups, by weight status, and changes during this century. METHODS We analyzed adult (≥20 y) anthropometric records from the US nationally representative Panel Study of Income Dynamics from 2001 to 2017. Among those not having obesity (body mass index, BMI, ≥30 kg/m2) at first observation, we used Poisson models to estimate the incidence of obesity [cases/1000 person-years (PYs)] and incidence rate ratio (IRR). RESULTS Among 13,888 adults followed for 115,797 PYs, the incidence of obesity in 2001-2017 was 28.1/1000 PYs (95% CI: 26.7, 29.7). Over the periods 2001-2005, 2005-2009, and 2009-2013, the incidence of obesity was stable, but in 2013-2017 the incidence increased by 18% compared to 2009-2013 [IRR: 1.18 (95% CI: 1.06, 1.30)]. Blacks had higher obesity incidence [47.9/1000 PYs (95% CI: 42.7, 53.1)] than Whites [26.2/1000 PYs (95% CI: 24.6, 27.9)]. Risk was particularly high among Black females [57.9/1000 PYs (95% CI: 49.1, 66.8)] and Black young adults (20-29 y) [65.5/1000 PYs (95% CI: 54.2, 76.7)]. Across race, obesity incidence was highest in young adults (20-29 y) [34.1/1000 PYs (95% CI: 31.5, 36.7)] and declined with age [age 70+ y: 18.9/1000 PYs (95% CI: 16.6, 21.8)]. Those with overweight had an obesity risk 7 times higher than those with normal weight [62.1/1000 PYs (95% CI: 58.8, 65.3) vs. 8.8/1000 PYs (95% CI: 8.1, 9.6)]. Those with less than high-school education had higher obesity incidence than those with education beyond high-school [39.4/1000 PYs (95% CI: 34.4, 44.4) vs. 24.7/1000 PYs (95% CI: 23.1, 26.3)]. CONCLUSIONS Incidence of obesity was stable over the first 13 y of the last 2 decades but increased by 18% in 2013-2017. Blacks and younger adults were at highest risk, and those with overweight were also at high risk for developing obesity.
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Affiliation(s)
- Jannie Nielsen
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Km Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Solveig A Cunningham
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Chandrasekar EK, Ali MK, Wei J, Narayan KV, Owens-Gary MD, Bullard KM. Trends in depression by glycemic status: Serial cross-sectional analyses of the National Health and Nutrition Examination Surveys, 2005-2016. Prim Care Diabetes 2022; 16:404-410. [PMID: 35272962 DOI: 10.1016/j.pcd.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
AIMS We examined changes in the prevalence of elevated depressive symptoms among US adults with diabetes, prediabetes, and normal glycemic status during 2005-2016. METHODS We analyzed data from 32,676 adults in the 2005-2016 National Health and Nutrition Examination Surveys. We defined diabetes as self-reporting a physician diagnosis of diabetes or A1C ≥ 6.5% [48 mmol/mol], and prediabetes as A1C 5.7-6.4% [39-46 mmol/mol]. We used the 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10 or antidepressant use to define 'clinically significant depressive symptoms' (CSDS) and PHQ-9 score ≥ 12 as 'Major Depressive Disorder' (MDD). We calculated prevalence age-standardized to the 2000 US census and used logistic-regression to compute adjusted odds of CSDS and MDD for 2005-2008, 2009-2012, and 2015-2016. We analyzed the prevalence of A1C ≥ 9.0% [75 mmol/mol], systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, non-HDL cholesterol ≥ 130 mg/dL, and current smoking among adults with diagnosed diabetes by depressive status. RESULTS The prevalence of CSDS increased among individuals with normal glycemic status from 15.0% (13.5-16.2) to 17.3% (16.0-18.7) (p = 0.03) over 2005-2016. The prevalence of CSDS and MDD remained stable among adults with prediabetes (~ 16% and 1%, respectively) and diabetes (~ 26% and ~3%). After controlling for glycemic, sociodemographic, economic, and self-rated health variables, we found 2-fold greater odds of CSDS among unemployed individuals and 3-fold greater odds among those with fair/poor self-rated health across all survey periods. Cardiometabolic care targets for adults with diagnosed diabetes were stable from 2005 to 2016 and similar across depressive status. CONCLUSIONS One-fourth of adults with diabetes have comorbid CSDS; this prevalence remained stable over 2005-2016 with no change in diabetes care. At the population level, depression does not appear to impact diabetes care, but further research could explore subgroups that may be more vulnerable and could benefit from integrated care that addresses both conditions.
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Affiliation(s)
- Eeshwar K Chandrasekar
- University of Rochester Medical Center, Rochester, NY 14642, USA; School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Mohammed K Ali
- School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Km Venkat Narayan
- School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Michelle D Owens-Gary
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Naser AM, Doza S, Rahman M, Unicomb L, Ahmed KM, Anand S, Selim S, Shamsudduha M, Narayan KV, Chang H, Clasen TF, Gribble MO, Luby SP. Consequences of access to water from managed aquifer recharge systems for blood pressure and proteinuria in south-west coastal Bangladesh: a stepped-wedge cluster-randomized trial. Int J Epidemiol 2021; 50:916-928. [PMID: 32653912 PMCID: PMC8271187 DOI: 10.1093/ije/dyaa098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Drinking-water salinity has been associated with high blood pressure (BP) among communities in south-west coastal Bangladesh. We evaluated whether access to water from managed aquifer recharge (MAR)—a hydrogeological intervention to lower groundwater salinity by infiltrating rainwater into the aquifers—can reduce community BP. Methods We conducted a stepped-wedge cluster-randomized trial with five monthly visits between December 2016 and April 2017 in 16 communities. At each visit following baseline, four communities were randomized to access MAR water. Systolic BP was the primary outcome, measured during each visit using Omron® HEM–907 devices. We also measured participants’ 24-hour urinary sodium and households’ drinking- and cooking-water salinity each visit. We used multilevel regression models to estimate the effects of MAR-water access on participants’ BP. The primary analysis was intention-to-treat. Results In total, 2911 person-visits were conducted in communities randomized to have MAR-water access and 2834 in communities without MAR-water access. Households without MAR-water access predominantly used low-salinity pond water and 42% (range: 26–50% across visits) of households exclusively consumed MAR water when access was provided. Communities randomized to MAR-water access had 10.34 [95% confidence interval (CI): 1.11, 19.58] mmol/day higher mean urinary sodium, 1.96 (95% CI: 0.66, 3.26; p = 0.004) mmHg higher mean systolic BP and 1.44 (95% CI: 0.40, 2.48; p = 0.007) mmHg higher mean diastolic BP than communities without MAR-water access. Conclusions Our findings do not support the scale-up of MAR systems as a routine drinking-water source, since communities that shifted to MAR water from the lower-salinity pond-water source had higher urinary sodium and BP.
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Affiliation(s)
- Abu Mohd Naser
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Solaiman Doza
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Kazi M Ahmed
- Department of Geology, University of Dhaka, Dhaka, Bangladesh
| | - Shuchi Anand
- Division of Nephrology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Mohammad Shamsudduha
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Department of Geography, University of Sussex, Brighton, UK
| | - Km Venkat Narayan
- Hubert Department of Global Health, Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew O Gribble
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
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Vashist K, Akintobi T, Bednarczyk RA, Narayan KV, Patel SA. Demographic benchmarks for equitable coverage of the COVID-19 vaccination program among priority populations. medRxiv 2021:2021.02.18.21251992. [PMID: 33655262 PMCID: PMC7924287 DOI: 10.1101/2021.02.18.21251992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report the demographic distribution of non-institutionalized populations in the US who are prioritized for COVID-19 vaccination by ethnicity, age and sex and region. The composition of non-institutionalized priority populations was estimated using a nationally representative sample of 25,417 adults interviewed in the National Health Interview Survey (NHIS) in 2018. A relatively large fraction of individuals prioritized for the earliest distribution of the vaccine are women, non-Hispanic Black, and young to middle aged adults. Overall, the study provides a platform to track equity in vaccine coverage and to better tailor health communication strategies.
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Anand S, Zheng Y, Montez-Rath ME, Wei WJ, Perico N, Carminati S, Narayan KV, Tandon N, Mohan V, Jha V, Zhang L, Remuzzi G, Prabahkaran D, Chertow GM. Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries. BMJ Glob Health 2017; 2:e000453. [PMID: 29071132 PMCID: PMC5640036 DOI: 10.1136/bmjgh-2017-000453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 11/03/2022] Open
Abstract
Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions—that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia—can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%–83.9%; in China and Nepal, 62.4%–66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.
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Affiliation(s)
- Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Wang Jin Wei
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China
| | - Norberto Perico
- Department of Biomedical and Clinical Sciences, Istitutodi Ricerche Farmacologiche Mario Negri, University of Milan, Milan, Province of Milan, Italy
| | - Sergio Carminati
- Department of Biomedical and Clinical Sciences, Istitutodi Ricerche Farmacologiche Mario Negri, University of Milan, Milan, Province of Milan, Italy
| | - Km Venkat Narayan
- Global Health and Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, Endocrinology, Madras Diabetes Research Foundation, Chennai, Tamil Naidu, India
| | - Vivekanand Jha
- George Institute for Global Health India, University of Oxford, New Delhi, India
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China
| | - Giuseppe Remuzzi
- Department of Biomedical and Clinical Sciences, Istitutodi Ricerche Farmacologiche Mario Negri, University of Milan, Milan, Province of Milan, Italy
| | | | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
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Mukherjee D, Safraj S, Tayyab M, Shivashankar R, Patel SA, Narayanan G, Ajay VS, Ali MK, Narayan KV, Tandon N, Prabhakaran D. Park availability and major depression in individuals with chronic conditions: Is there an association in urban India? Health Place 2017; 47:54-62. [PMID: 28753524 DOI: 10.1016/j.healthplace.2017.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/22/2017] [Accepted: 07/18/2017] [Indexed: 01/24/2023]
Abstract
Green space exposure has been positively correlated with better mental-health indicators in several high income countries, but has not been examined in low- and middle-income countries undergoing rapid urbanization. Building on a study of mental health in adults with a pre-existing chronic condition, we examined the association between park availability and major depression among 1208 adults surveyed in Delhi, India. Major depression was measured using the Mini International Neuropsychiatric Interview. The ArcGIS platform was used to quantify park availability indexed as (i) park distance from households, (ii) area of the nearest park; and within one km buffer area around households - the (iii) number and (iv) total area of all parks. Mixed-effects logistic regression models adjusted for socio-demographic characteristics indicated that relative to residents exposed to the largest nearest park areas (tertile 3), the odds [95% confidence interval] of major depression was 3.1 [1.4-7.0] times higher among residents exposed to the smallest nearest park areas (tertile 1) and 2.1 [0.9-4.8] times higher in residents with mid-level exposure (tertile 2). There was no statistically significant association between other park variables tested and major depression. We hypothesized that physical activity in the form of walking, perceived stress levels and satisfaction with the neighborhood environment may have mediating effects on the association between nearest park area and major depression. We found no significant mediation effects for any of our hypothesized variables. In conclusion, our results provide preliminary and novel evidence from India that availability of large parks in the immediate neighborhood positively impacts mental well-being of individuals with pre-existing chronic conditions, at the opportune time when India is embarking on the development of sustainable cities that aim to promote health through smart urban design - one of the key elements of which is the inclusion of urban green spaces.
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Affiliation(s)
- Debarati Mukherjee
- Centre for Control of Chronic Conditions, Gurgaon, India; Public Health Foundation of India, Gurgaon, India
| | - S Safraj
- Centre for Control of Chronic Conditions, Gurgaon, India; Public Health Foundation of India, Gurgaon, India
| | - Mohammad Tayyab
- Public Health Foundation of India, Gurgaon, India; Jamia Milia Islamia, New Delhi, India
| | - Roopa Shivashankar
- Centre for Control of Chronic Conditions, Gurgaon, India; Centre for Chronic Disease Control, Gurgaon, India; Public Health Foundation of India, Gurgaon, India
| | - Shivani A Patel
- Centre for Control of Chronic Conditions, Gurgaon, India; Rollins School of Public Health, Emory University, USA
| | - Gitanjali Narayanan
- Centre for Chronic Disease Control, Gurgaon, India; National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vamadevan S Ajay
- Centre for Control of Chronic Conditions, Gurgaon, India; Centre for Chronic Disease Control, Gurgaon, India; Public Health Foundation of India, Gurgaon, India
| | - Mohammed K Ali
- Centre for Control of Chronic Conditions, Gurgaon, India; Rollins School of Public Health, Emory University, USA
| | - Km Venkat Narayan
- Centre for Control of Chronic Conditions, Gurgaon, India; Rollins School of Public Health, Emory University, USA
| | - Nikhil Tandon
- Centre for Control of Chronic Conditions, Gurgaon, India; All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Control of Chronic Conditions, Gurgaon, India; Centre for Chronic Disease Control, Gurgaon, India; Public Health Foundation of India, Gurgaon, India; London School of Hygiene&Tropical Medicine, UK.
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Rao D, Lipira L, Kumar S, Mohanraj R, Poongothai S, Tandon N, Sridhar GR, Katon W, Narayan KV, Chwastiak L, Mohan V, Ali MK. Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INDEPENDENT Study. Int J Noncommun Dis 2016; 1:65-75. [PMID: 29075675 DOI: 10.4103/2468-8827.191979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. METHODS At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach. RESULTS Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma). CONCLUSIONS Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
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Affiliation(s)
- Deepa Rao
- Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington, Seattle, USA
| | - Shuba Kumar
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subramani Poongothai
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Km Venkat Narayan
- Department of Global Health and Epidemiology; Department of Medicine, Emory University, Atlanta, GA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohammed K Ali
- Department of Medicine, Emory University, Atlanta, GA, USA
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Nicoll PM, Narayan KV, Paterson JG. Cervical cancer screening: women's knowledge, attitudes and preferences. Health Bull (Edinb) 1991; 49:184-90. [PMID: 1917453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Screening status of women aged 20-64 registered with a large group practice was determined using laboratory and general practice records. A postal survey was carried out on 1,416 women divided into: 1. 'Non-attenders'--never had a smear. 2. 'Defaulters'--smear more than five years ago. 3. 'Attenders'--smear in last five years. Screening status was related to social class and education. Single and nulliparous women were less likely to have been screened. Knowledge of the test was poor in all three groups. Most women were willing to have a smear performed and previous non-attendance might have been overcome by a call/recall system. The woman's general practitioner was the preferred taker of smears, regardless of sex. Of those willing to have the test 95% would attend the general practitioner if no alternative was provided. Improved uptake depends on an organised call/recall system with smear taking based in primary care, and on improved health education.
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Affiliation(s)
- P M Nicoll
- Department of Public Health Medicine, Grampian Health Board, Aberdeen
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