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Macciotta A, Sacerdote C, Giachino C, Di Girolamo C, Franco M, van der Schouw YT, Zamora-Ros R, Weiderpass E, Domenighetti C, Elbaz A, Truong T, Agnoli C, Bendinelli B, Panico S, Vineis P, Christakoudi S, Schulze MB, Katzke V, Bajracharya R, Dahm CC, Dalton SO, Colorado-Yohar SM, Moreno-Iribas C, Etxezarreta PA, Sanchez MJ, Forouhi NG, Wareham N, Ricceri F. Examining causal relationships between educational attainment and type 2 diabetes using genetic analysis: findings from the EPIC-InterAct study through Mendelian randomisation. J Epidemiol Community Health 2025; 79:373-379. [PMID: 39658133 PMCID: PMC12015027 DOI: 10.1136/jech-2024-222734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/19/2024] [Indexed: 12/12/2024]
Abstract
INTRODUCTION Observational studies have shown that more educated people are at lower risk of developing type 2 diabetes (T2D). However, robust study designs are needed to investigate the likelihood that such a relationship is causal. This study used genetic instruments for education to estimate the effect of education on T2D using the Mendelian randomisation (MR) approach. METHODS Analyses have been conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study (more than 20 000 individuals), a case-cohort study of T2D nested in the EPIC cohort. Education was measured as Years of Education and Relative Index of Inequality. Prentice-weighted Cox models were performed to estimate the association between education and T2D. One-sample MR analyses investigated whether genetic predisposition towards longer education was associated with risk of T2D and investigated potential mediators of the association. RESULTS MR estimates indicated a risk reduction of about 15% for each year of longer education on the risk of developing T2D, confirming the protective role estimated by observational models (HR 0.96, 95% CI 0.95 to 0.96). MR analyses on putative mediators showed a significant role of education on body mass index, alcohol consumption, adherence to the Mediterranean diet and smoking habits. CONCLUSION The results supported the hypothesis that higher education is a protective factor for the risk of developing T2D. Based on its position in the causal chain, education may be antecedent of other known risk factors for T2D including unhealthy behaviours. These findings reinforce evidence obtained through observational study designs and bridge the gap between correlation and causation.
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Affiliation(s)
- Alessandra Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Carlotta Sacerdote
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Claudia Giachino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Chiara Di Girolamo
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Matteo Franco
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | | | - Cloé Domenighetti
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Alexis Elbaz
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Benedetta Bendinelli
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Department of Inflammation Biology, King's College London, London, UK
| | - Matthias B Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research, Neuherberg, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | | | | | - Christina C Dahm
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
- Department for Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Sandra M Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBERESP, Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | | | - Pilar Amiano Etxezarreta
- CIBERESP, Madrid, Spain
- Ministry of Health of the Basque Government, San Sebastián, Spain
- BioGipuzkoa Health Research Institute, San Sebastián, Spain
| | - María José Sanchez
- CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Nita G Forouhi
- MRC Epidemiology, University of Cambridge, Cambridge, UK
| | | | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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Karaca-Çelik KE, Toprak D, Baş M, Tevfikoğlu L, Kahrıman M, İnce-Palamutoglu M, Doğan N, Baş D. Evaluation of sociodemographic and nutrition-related factors for type 2 diabetes risk: a sample from Turkiye. BMC Public Health 2025; 25:858. [PMID: 40038651 PMCID: PMC11877910 DOI: 10.1186/s12889-025-21940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 02/13/2025] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Considering the increasing prevalence of diabetes, we aimed to evaluate the risk of diabetes in our sample and its relationship with sociodemographic and nutrition-related factors. METHODS We conducted the study in Afyonkarahisar province of Turkiye with participants aged 18-65 years. In this face-to-face study, we used a questionnaire on sociodemographic information and general dietary habits and the FINDRISC screening tool. We also recorded participants' 24-hour food recall and assessed anthropometric measurements. We analyzed epidemiological data using binary logistic regression models to assess possible risk factors associated with the presence of diabetes risk. RESULTS Overall, this study included 3,990 participants, 50.03% (n = 1996) and 49.97% (n = 1994) of whom were males and females, respectively. The FINDRISC score was higher in females (p = 0.001), married individuals (p < 0.001), those with lower education levels (p < 0.001), and participants diagnosed with the disease by a doctor (p < 0.001). Additionally, having a body mass index (BMI) of > 30 kg/m2 increased the risk by 7.33 folds compared with having a BMI of < 25 kg/m2. Significant but very low correlation coefficients were found between main meal consumption, energy, lipid and iron intake and diabetes risk (p < 0.001). CONCLUSIONS Our findings suggest that increasing age, increasing BMI, lower education level, and having a disease diagnosis can be significant risk factors for diabetes. However, more studies are needed to clarify risk factors, especially those related to nutrition.
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Affiliation(s)
- K Esen Karaca-Çelik
- Izmir Demokrasi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Türkiye
| | - Dilek Toprak
- Istanbul Atlas University, Department of Family Medicine, Faculty of Medicine, Istanbul, Türkiye
| | - Murat Baş
- Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Türkiye
| | - Leyla Tevfikoğlu
- Trakya University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Edirne, Türkiye
| | - Meryem Kahrıman
- Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Türkiye.
| | - Merve İnce-Palamutoglu
- Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Afyonkarahisar, Türkiye
| | - Nurhan Doğan
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Afyonkarahisar, Türkiye
| | - Dilşat Baş
- Istanbul Galata University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Türkiye
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Taylor K, Marston L, Mukadam N. Mediation of the association between education and dementia by occupational complexity, income, health behaviours and health outcomes. BMC Psychiatry 2025; 25:174. [PMID: 40001002 PMCID: PMC11863402 DOI: 10.1186/s12888-025-06619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/03/2023] [Accepted: 02/17/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Many studies observe a negative association between education and all-cause dementia, however, little is known about how the association develops. Current evidence regarding mediatory factors is limited, conflicted and suggests a complex relationship. In this study we used UK Biobank data to determine to what extent multiple factors mediate the association. METHODS Data was sourced from UK Biobank and multiple imputation used to replace missing values. Education was measured at baseline assessment and dementia diagnosis determined from self-report or linked healthcare records. Five potential mediators were considered: Social isolation, income and occupational complexity were measured at baseline and health behaviour and health outcome scores derived. Logistic regression was used to examine the association between education and dementia with adjustment for potential mediators. Causal mediation analysis was then performed to determine the proportion of the dementia education association occurring via each mediatory pathway. RESULTS In a sample of 384,284 participants, higher level of education was associated with reduced odds of dementia. When considered as a confounder, occupational complexity almost fully attenuated the association (OR: 0.94, CI: 0.89-0.99) and was found to mediate 73% of the association. Average income, health outcomes and health behaviours also acted as mediators, explaining 10%, 27% and 35% of the relationship respectively. CONCLUSIONS Occupational complexity mediates a large proportion of the association between education and dementia. Intervention to improve access to cognitively stimulating work and leisure activities, particularly to those who are less educated, may reduce the number of people in the UK living with dementia.
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Affiliation(s)
- Katherine Taylor
- Division of Biosciences, Medical Sciences Building, University College London, Gower Street, London, WC1E 6BT, U.K..
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, U.K
| | - Naaheed Mukadam
- UCL Division of Psychiatry, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, U.K
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, U.K
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Okyere J, Ayebeng C, Dickson KS. Prevalence of diabetes and its associated factors in Cape Verde: an analysis of the 2020 WHO STEPS survey on non-communicable diseases risk factors. BMC Endocr Disord 2024; 24:264. [PMID: 39696309 DOI: 10.1186/s12902-024-01803-1] [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: 04/24/2024] [Accepted: 12/05/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) represents a significant global health challenge, with its prevalence steadily rising across diverse populations. Understanding the factors associated with T2DM is crucial for effective prevention and management strategies. In Cape Verde, an archipelago nation off the coast of West Africa, the burden of T2DM is of particular concern, yet comprehensive studies investigating its determinants in this context remain sparse. This study aims to narrow the knowledge gap by assessing the prevalence of prediabetes, T2DM and its associated factors among the adult Cape Verdean population. METHODS Data from the WHO STEPs survey were used. We analyzed data from 1,936 adults aged 18-69 years. The outcome variable was diabetes status computed using the fasting blood glucose (mg/dl). The data was weighted before the analysis to account for sampling biases. Multinomial logistic regression models were computed in STATA version 18. RESULTS The overall prevalence of prediabetes and T2DM was 7.8% (95% CI: 6.1-9.9) and 3.9% (95% CI: 3.1-4.9), respectively. Increasing age was associated with a higher odd of prediabetes and T2DM with the highest odds observed among older adults [(prediabetes: AORs = 3.20, 95%CI: 1.88-5.54) and T2DM: AOR = 3.51, 95%CI: 1.71-7.18)]. Additionally, high total cholesterol levels were linked to increased odds of T2DM (AOR = 2.48, 95%CI: 1.64-3.76). Individuals who consumed less than four servings of vegetables daily had higher odds of T2DM (AOR = 1.74, 95%CI: 1.12-2.71) while being overweight/obese was associated with higher odds of prediabetes (AOR = 1.57, 95%CI: 1.10-2.23). Urban residents had higher odds of T2DM than rural residents (AOR = 1.92, 95%CI: 1.23-3.00). Also, higher educational attainment was associated with lower odds of T2DM only (AOR = 0.33, 95%CI: 0.12-0.88) but not statistically significant for prediabetes. CONCLUSION Based on the findings, we conclude that ageing, overweight/obesity, vegetable consumption and total cholesterol level are important predictors of pre-diabetes and T2DM in Cape Verde. As such, weight management and cholesterol management should be integral parts of T2DM prevention strategies. Additionally, clinicians and diabetes societies in Cape Verde must make the promotion of vegetable consumption a key component of their health advice and advocacy. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, United Kingdom.
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Demography, Australian National University, Canberra, ACT, Australia
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Fang CY, Rao A, Handorf EA, Deng M, Cheung P, Tseng M. Increases in Psychological Stress Are Associated With Higher Fasting Glucose in US Chinese Immigrants. Ann Behav Med 2024; 58:799-808. [PMID: 39316655 DOI: 10.1093/abm/kaae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND The majority of Chinese Americans is foreign-born, and it is well-documented that immigration to the United States (US) leads to increased risk for chronic diseases including type 2 diabetes. Increased disease risk has been attributed to changes in lifestyle behaviors following immigration, but few studies have considered the psychosocial impact of immigration upon biomarkers of disease risk. PURPOSE To examine associations of psychological stress and social isolation with markers of type 2 diabetes risk over time among US Chinese immigrants. METHODS In this longitudinal study of 614 Chinese immigrants, participants completed assessments of perceived stress, acculturative stress, negative life events, and social isolation annually at three time points. Fasting blood samples were obtained at each time point to measure blood glucose, glycated hemoglobin, and insulin resistance. Mean duration between baseline and follow-up assessments was approximately 2 years. RESULTS Increases in migration-related stress, perceived stress and social isolation were associated with significant increases in fasting glucose at follow-up independent of age, body mass index, length of US residence, and other potential covariates. Moreover, increases in glucose varied depending on perceived stress levels at baseline, such that those with higher baseline stress had a steeper increase in glucose over time. CONCLUSIONS Psychological stress and social isolation are associated with increases in fasting glucose in a sample of US Chinese immigrants. Findings suggest that the unique experiences of immigration may be involved in the risk of developing type 2 diabetes, a condition that is prevalent among US Chinese despite relatively low rates of obesity.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention & Control Program, Fox Chase Cancer Center, USA
| | - Ajay Rao
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
- Center for Metabolic Disease Research, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | | | - Mengying Deng
- Department of Biostatistics & Bioinformatics, Fox Chase Cancer Center, USA
| | - Peter Cheung
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | - Marilyn Tseng
- Department of Kinesiology and Public Health, California Polytechnic State University, USA
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Gordon NP, Pimentel M. Differences in the Relationship Between Educational Attainment and Health Status Across Racial and Ethnic Groups in a Multi-ethnic United States Older Adult Population: A Cross-Sectional Electronic Health Record-Based Study. Cureus 2024; 16:e73288. [PMID: 39655127 PMCID: PMC11626993 DOI: 10.7759/cureus.73288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2024] [Indexed: 12/12/2024] Open
Abstract
Introduction We aimed to describe the relationship of educational attainment with the prevalence of six health outcomes (ever and current smoking, diabetes, hypertension, coronary artery disease, and chronic obstructive pulmonary disease) in an older adult population, including whether education-health relationships differed by health outcome, by racial and ethnic (racial/ethnic) group, and by racial/ethnic group within the same level of education. Methods This cross-sectional study used 2015-2016 electronic health record data for 149,417 non-Hispanic White (White), 15,398 African-American or other Black (Black), 15,319 Hispanic or Latino (Latino), 10,133 Filipino, and 8810 Chinese Northern California health plan members aged 65-79 years whose preferred language was English. For each racial/ethnic group, sex-specific age-standardized prevalence of the six health outcomes was estimated for four levels of education (non-high school graduate, high school graduate, some college, college graduate). Age-adjusted prevalence ratios were used to compare the prevalence between adjacent levels of education and at lower versus college graduate levels within racial/ethnic groups, and the prevalence between White adults and adults in the other racial/ethnic groups, within each level of education and overall. Results The education-health relationship varied across racial/ethnic groups and health outcomes, with gradient relationships more consistently seen for White, Black, and Latino older adults than Filipino and Chinese older adults. Even when a gradient relationship was not observed, the prevalence at the college graduate level was usually significantly lower than the prevalence at the three lower levels of education. The prevalence of current smoking, diabetes, and hypertension was higher among Black than White adults at most levels of education. Controlling for education level minimally affected comparisons of overall prevalence of health outcomes between adults in the White and the other racial/ethnic groups, with the broadest impact seen for Latino-White comparisons. Conclusions The relationship of level of education and health outcomes differs across racial/ethnic groups and by health outcome. This should be taken into consideration when using education as a risk adjustment factor or predictor of health outcomes in multi-ethnic older adult populations.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente, Pleasanton, USA
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Fazekas-Pongor V, Domján BA, Major D, Péterfi A, Horváth VJ, Mészáros S, Vokó Z, Vásárhelyi B, Szabó AJ, Burián K, Merkely B, Tabák AG. Prevalence and determinants of diagnosed and undiagnosed diabetes in Hungary based on the nationally representative cross-sectional H-UNCOVER study. Diabetes Res Clin Pract 2024; 216:111834. [PMID: 39168185 DOI: 10.1016/j.diabres.2024.111834] [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: 05/15/2024] [Revised: 08/02/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024]
Abstract
AIMS To estimate prevalence of diagnosed (dDM) and undiagnosed diabetes (uDM) in Hungary and investigate determinants of uDM. METHODS Data was obtained from the nationally representative H-UNCOVER study. As laboratory measurements were available for 11/19 Hungarian counties, n = 5,974/17,787 people were eligible. After exclusions, 5,673 (representing 4,976,097 people) were included. dDM was defined by self-reporting, while uDM as negative self-reporting and elevated fasting glucose (≥7 mmol/l) and/or HbA1c (≥48 mmol/mol). Logistic regression for complex samples was used to calculate comparisons between dDM and uDM adjusted for age and BMI. RESULTS Diabetes prevalence was 12.0 %/11.9 % (women/men, 95 %CI:10.7-13.4 %/10.7-13.2 %), while 2.2 %/2.8 % (1.7-2.8 %/2.2-3.6 %) of women/men were uDM. While the proportion of uDM vs. dDM was similar for women ≥ 40, men in their forties had the highest odds for uDM. Neither unemployment (women/men OR:0.58 [0.14-2.45]/0.50 [0.13-1.92]), nor education level (tertiary vs. primary; women/men OR: 1.16 [0.53-2.56]/ 0.53 [0.24-1.18]) were associated with uDM. The risk of uDM was lower in both sexes with chronic morbidities. CONCLUSIONS We report higher prevalence of diabetes and undiagnosed diabetes than previous Hungarian estimates. The finding that socioeconomic factors are not associated to uDM suggests that universal health care could provide equitable access to diabetes diagnosis.
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Affiliation(s)
- Vince Fazekas-Pongor
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary.
| | - Beatrix A Domján
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Dávid Major
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Anna Péterfi
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Viktor J Horváth
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Szilvia Mészáros
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; Syreon Research Institute, Mexikói út 65/A, Budapest H-1126, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Attila J Szabó
- Pediatric Center, Semmelweis University, Bókay János u. 53-54, Budapest H-1083, Hungary
| | - Katalin Burián
- Department of Clinical Microbiology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary
| | - Adam G Tabák
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest H-1085, Hungary; UCL Brain Sciences, University College London, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
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Reinke C. The effect of diabetes in the multifaceted relationship between education and cognitive function. BMC Public Health 2024; 24:2584. [PMID: 39334040 PMCID: PMC11429487 DOI: 10.1186/s12889-024-20156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/23/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Education has been shown to be positively associated with cognitive performance. However, the pathways via lifestyle-related disease through which education is related to cognitive performance have not been sufficiently explored. Diabetes is an important lifestyle-related disease with increasing prevalence worldwide. Low education is associated with an increased risk of developing diabetes, while diabetes may also lead to a deterioration in cognitive performance. This study aims to explore if the associations between education and cognitive function is mediated by the diabetes status among older adults. METHODS The data utilized in this study were derived from the first two waves of the Dutch Lifelines Cohort Study (2006-2015). The analyzed sample included 26,131 individuals aged 50 years or above at baseline. The baseline assessment included measurements of educational attainment (exposure) and the potential mediator diabetes. The outcome of cognitive function was assessed using age-standardized reaction times from the psychomotor function and attention tasks, as measured by the Cogstate Brief Battery. The Cogstate Brief Battery was only conducted at the follow-up assessment, not at the baseline assessment. Faster reaction times correspond to higher cognitive performance. The study employed linear and logistic regression models, in addition to a causal mediation approach which estimated the average causal mediation effect (ACME). RESULTS Higher education was associated with a lower risk of diabetes (b= -0.1976, 95%CI= -0.3354; -0.0597) compared to low or middle education as well as with faster reaction times (b= -0.2023, 95%CI= -0.2246; -0.1798), implying better cognitive function. Diabetes was associated with slower reaction times (b = 0.0617, 95%CI = 0.0162; 0.1072). Most importantly, the mediation approach identified a significant indirect effect of education on cognitive function via the diabetes status (ACME= -0.00061, 95%CI= -0.00142; -0.00011). DISCUSSION The findings emphasize the potentially importance of diabetes in explaining the role of education in promoting healthy cognitive function and mitigating the risk of cognitive decline. Early detection and treatment of diabetes may be particularly beneficial for individuals with low or middle levels of education in order to maintain good levels of cognitive function.
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Affiliation(s)
- Constantin Reinke
- Institute for Sociology and Demography, University of Rostock, Ulmenstr. 69, 18057, Rostock, Germany.
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Lee MJ, Seo BJ, Kim YS. Impact of Education as a Social Determinant on the Risk of Type 2 Diabetes Mellitus in Korean Adults. Healthcare (Basel) 2024; 12:1446. [PMID: 39057589 PMCID: PMC11276317 DOI: 10.3390/healthcare12141446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/06/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Education is correlated with health literacy, which is a combination of reading and listening skills, data analysis, and decision-making during the necessary health situations. This study aims to evaluate the effect of education on the risk of type 2 diabetes mellitus (T2DM). This is a population-based cross-sectional study using the 2019 nationwide survey data in Korea. There were 3951 study subjects, after excluding participants with missing data for key exposures and outcome variables. Descriptive statistics, χ2 (chi-square) test, and logistic regression were performed to analyze the data. The prevalence of T2DM was associated with educational attainment, sex, age, smoking status, physical activity, carbohydrate intake, and obesity. In the logistic regression model, the odds ratio (OR) of having T2DM was much lower among people educated in college or higher (OR = 0.49, 95% confidence interval [95% CI] = 0.34-0.64) than those with only or without primary education after adjusting for biological factors (sex, age) and health behaviors (smoking status, physical activity, carbohydrate intake, and obesity). This study shows that educational attainment is a significant social determinant influencing health outcomes both directly and indirectly. Therefore, it is necessary to develop policies to reduce the health inequity of T2DM caused by differences in educational attainment.
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Affiliation(s)
- Mi-Joon Lee
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Bum-Jeun Seo
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Yeon-Sook Kim
- Department of Nursing, California State University San Bernardino, San Bernardino, CA 92407, USA;
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Dynesen AW, Pedersen SG, Lorenzen JK, Lehn SF. Nearly one in five older adults in Danish nursing homes live with type 2 diabetes. Scand J Public Health 2024; 52:397-401. [PMID: 36468770 PMCID: PMC11179306 DOI: 10.1177/14034948221139648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to investigate the prevalence of type 2 diabetes (T2D) among Danish nursing home residents (aged ⩾65 years). METHODS Individuals with T2D in the Danish population of older adults in 2018 were identified using a Danish diabetes register based on administrative and clinical register data. Data on age, sex, type of housing, educational level and place of origin were obtained from various high-quality administrative registers. We calculated frequencies of T2D among older adults living in nursing homes and in other types of housing. We performed a multiple logistic regression analysis to estimate the odds ratio (OR) of T2D among people living in nursing homes and adjusted for sex, age, educational level and place of origin. RESULTS All Danish older adults aged ⩾65 years, alive and living in Denmark on 31 December 2018 were included (N=1,170,517). Nursing home residents accounted for 37,891 older adults, and of these, 19% had T2D, whereas 14% of older adults living in other types of housing had T2D. According to the multiple logistic regression analysis, nursing home residents had a higher OR of having T2D compared to older adults living in other types of housing (OR=1.47; confidence interval 1.43-1.51) when adjusting for socio-demographic factors. CONCLUSIONS The prevalence of T2D in nursing home residents exceeds the prevalence in the background population at ⩾65 years of age. This indicates a need for increased focus on individualised interdisciplinary care plans aimed at maintaining physical function and maximising quality of life for this group of vulnerable older adults.
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Affiliation(s)
- Anja W. Dynesen
- Centre for Nutrition, Rehabilitation and Midwifery, University College Absalon, Denmark
| | | | | | - Sara F. Lehn
- Steno Diabetes Center Zealand, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
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11
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Kovács N, Shahin B, Andrade CAS, Mahrouseh N, Varga O. Lifestyle and metabolic risk factors, and diabetes mellitus prevalence in European countries from three waves of the European Health Interview Survey. Sci Rep 2024; 14:11623. [PMID: 38773149 PMCID: PMC11109107 DOI: 10.1038/s41598-024-62122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
Population shift towards healthier lifestyles can help reduce the burden of type 2 diabetes mellitus (DM), therefore understanding and monitoring the lifestyle-related risk factors are crucial for setting up effective preventive strategies and disease management. The present study aimed to explore the changes in prevalence of DM and major risk factors including smoking, physical activity, fruit and vegetable consumption, as well as body mass index (BMI) over three waves of European Health Interview Survey, and to investigate the association between risk factors and presence of DM across 11 European Union member states. Poisson regression models were used to evaluate the association between risk factors and DM, adjusted for demographic and socioeconomic variables. The estimated age-standardized prevalence of DM increased from 7.01% in 2009 to 7.96% in 2019, with substantial increase in subgroups with higher BMI and unhealthy lifestyle including physically inactive people, or current smokers. Obesity and overweight and physical inactivity were significantly associated with DM in all survey waves. Our findings underline that obesity prevention and weight loss promotion along with physical activity promotion are the subject of lifestyle interventions to reduce the burden of DM in EU member states.
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Affiliation(s)
- Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balqees Shahin
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Syreon Research Institute, Budapest, Hungary.
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12
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Zhang X, Yip TCF, Tse YK, Hui VWK, Li G, Lin H, Liang LY, Lai JCT, Lai MSM, Cheung JTK, Chan HLY, Chan SL, Kong APS, Wong GLH, Wong VWS. Trends in risk factor control and treatment among patients with non-alcoholic fatty liver disease and type 2 diabetes between 2000 and 2020: A territory-wide study. Aliment Pharmacol Ther 2023; 57:1103-1116. [PMID: 36815548 DOI: 10.1111/apt.17428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/03/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND & AIMS We aimed to determine the trends in risk factor control and treatment among patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D) in 2000-2020. METHODS We conducted a territory-wide cohort study of adult patients with NAFLD and T2D diagnosed between 1 January 2000 and 31 July 2021 in Hong Kong. T2D was defined by use of any anti-diabetic agents, laboratory tests and/or diagnosis codes. RESULTS This study included 16,084 patients with NAFLD and T2D (mean age, 54.8 ± 12.0 years; 7124 male [44.3%]). The percentage of patients achieving individualised haemoglobin A1c (HbA1c ) targets increased from 44.5% (95% confidence interval [CI], 42.9-46.1) to 64.8% (95% CI, 64.1-65.5), and percentage of patients achieving individualised low-density lipoprotein-cholesterol (LDL-C) targets increased from 23.3% (95% CI, 21.9-24.7) to 54.3% (95% CI, 53.5-55.1) from 2000-2005 to 2016-2020, whereas percentage of patients achieving blood pressure control (<140/90 mm Hg) remained static at 53.1-57.2%. Combination therapy for diabetes increased, especially among those with poor glycaemic control, but there was no increase in combination therapy for hypertension. Fewer cirrhotic patients achieved blood pressure control and individualised LDL-C targets, but they were more likely to achieve individualised HbA1c targets than non-cirrhotics. Metformin and statins were underused in cirrhotic patients. Younger patients (18-44 years) were less likely to achieve individualised HbA1c targets than middle-aged (45-64 years) and older ones (≥65 years). CONCLUSIONS From 2000 to 2020, glycaemic and lipid control improved significantly, whereas blood pressure control remained static among patients with NAFLD and T2D.
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Affiliation(s)
- Xinrong Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Vicki Wing-Ki Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Guanlin Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Huapeng Lin
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Lilian Yan Liang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jimmy Che-To Lai
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Mandy Sze-Man Lai
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Johnny T K Cheung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Henry Lik-Yuen Chan
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- Department of Internal Medicine, Union Hospital, Hong Kong, China
| | - Stephen Lam Chan
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
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13
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Kesireddy V, Kluwe B, Pohlman N, Zhao S, Tan Y, Kline D, Brock G, Odei JB, Effoe VS, Echouffo-Tcheugui JB, Kalyani RR, Sims M, Taylor HA, Mongraw-Chaffin M, Akhabue E, Joseph JJ. The role of aldosterone and ideal cardiovascular health in incident diabetes: The Jackson Heart Study. Am J Prev Cardiol 2023; 13:100466. [PMID: 36798725 PMCID: PMC9926093 DOI: 10.1016/j.ajpc.2023.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/10/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023] Open
Abstract
Background Greater attainment of ideal cardiovascular health (ICH) and lower serum aldosterone are associated with lower diabetes risk. Higher levels of ICH are associated with lower aldosterone. The mediational role of aldosterone in the association of ICH with incident diabetes remains unexplored. Thus, we examined the mediational role of aldosterone in the association of 5 ICH components (smoking, diet, physical activity, body mass index [BMI], and cholesterol) with incident diabetes. Additionally, we investigated the mediational role of glucose and blood pressure (BP) in the association of aldosterone with incident diabetes in an African American (AA) cohort. Methods We conducted a prospective cohort analysis among AA adults, aged 21-94 years, in the Jackson Heart Study. Data on ICH, aldosterone, and cardiometabolic risk factors were collected at exam 1 (2000-2004). Diabetes (fasting glucose ≥ 126 mg/dL, physician diagnosis, use of diabetes drugs, or glycated hemoglobin ≥ 6.5%) was assessed at exams 1 through 3 (2009-2012). ICH metrics were defined by American Heart Association 2020 goals for smoking, dietary intake, physical activity, BMI, total cholesterol, BP and glucose. The number of ICH metrics attained at exam 1, excluding BP and fasting glucose, were summed (0-2, vs. 3+). R Package Mediation was used to examine: 1) The mediational role of aldosterone in the association of ICH with incident diabetes; and 2) the mediational role of BP and glucose in the association of aldosterone with incident diabetes. Results Among 2,791 participants (mean age: 53±12, 65% female) over a median of 7.5 years, there were 497 incident diabetes cases. Risk of incident diabetes was 37% (HR: 0.63, 95%CI: 0.47, 0.84) lower in 3+ ICH category compared to 0-2 ICH category. Aldosterone mediated 6.98% (95% CI: 1.8%, 18.0%) of the direct effect of ICH on incident diabetes. A 1-unit increase in log-aldosterone was associated with a 44% higher risk of diabetes (HR 1.44, 95%CI 1.25-1.64). BP and glucose mediated 16.3% (95% CI: 7.0%, 31.0%) and 19.7% (95% CI: 6.5%, 34.0%) of the association of aldosterone with incident diabetes, respectively. Conclusion Aldosterone is a mediator of the association of ICH with incident diabetes, whereas BP and glucose are mediators of the association of aldosterone with incident diabetes, emphasizing the importance of the renin-angiotensin-aldosterone system and ICH in lowering risk of diabetes in AA populations.
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Affiliation(s)
- Veena Kesireddy
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States of America
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bjorn Kluwe
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States of America
| | - Neal Pohlman
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States of America
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Yubo Tan
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - David Kline
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem NC 27157, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - James B. Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Valery S. Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Herman A. Taylor
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ehimare Akhabue
- Division of Cardiovascular Diseases and Hypertension, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Joshua J. Joseph
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States of America
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14
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Islam MM, Rahman MJ, Menhazul Abedin M, Ahammed B, Ali M, Ahmed NF, Maniruzzaman M. Identification of the risk factors of type 2 diabetes and its prediction using machine learning techniques. Health Syst (Basingstoke) 2022; 12:243-254. [PMID: 37234468 PMCID: PMC10208154 DOI: 10.1080/20476965.2022.2141141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
This study identified the risk factors for type 2 diabetes (T2D) and proposed a machine learning (ML) technique for predicting T2D. The risk factors for T2D were identified by multiple logistic regression (MLR) using p-value (p<0.05). Then, five ML-based techniques, including logistic regression, naïve Bayes, J48, multilayer perceptron, and random forest (RF) were employed to predict T2D. This study utilized two publicly available datasets, derived from the National Health and Nutrition Examination Survey, 2009-2010 and 2011-2012. About 4922 respondents with 387 T2D patients were included in 2009-2010 dataset, whereas 4936 respondents with 373 T2D patients were included in 2011-2012. This study identified six risk factors (age, education, marital status, SBP, smoking, and BMI) for 2009-2010 and nine risk factors (age, race, marital status, SBP, DBP, direct cholesterol, physical activity, smoking, and BMI) for 2011-2012. RF-based classifier obtained 95.9% accuracy, 95.7% sensitivity, 95.3% F-measure, and 0.946 area under the curve.
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Affiliation(s)
- Md. Merajul Islam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | | | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Mohammad Ali
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - N.A.M Faisal Ahmed
- Institute of Education and Research, University of Rajshahi, Rajshahi, Bangladesh
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15
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Zhu Y, Hu C, Lin L, Wang S, Lin H, Huo Y, Wan Q, Qin Y, Hu R, Shi L, Su Q, Yu X, Yan L, Qin G, Tang X, Chen G, Xu M, Xu Y, Wang T, Zhao Z, Gao Z, Wang G, Shen F, Luo Z, Chen L, Li Q, Ye Z, Zhang Y, Liu C, Wang Y, Wu S, Yang T, Deng H, Chen L, Zeng T, Zhao J, Mu Y, Wang W, Ning G, Bi Y, Chen Y, Lu J. Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study. J Diabetes 2022; 14:739-748. [PMID: 36217863 PMCID: PMC9705800 DOI: 10.1111/1753-0407.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/06/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence regarding the impact of education on diabetes risk is scarce in developing countries. We aimed to explore the association between education and diabetes within a large population in China and to identify the possible mediators between them. METHODS Information on educational level and lifestyle factors was collected through questionnaires. Diabetes was diagnosed from self-report and biochemical measurements. A structural equation model was constructed to quantify the mediation effect of each mediator. RESULTS Compared with their least educated counterparts, men with college education had a higher risk of diabetes (odds ratio [OR] 1.19; 95% confidence interval [CI], 1.12-1.27), while college-educated women were less likely to have diabetes (OR 0.77; 95% CI, 0.73-0.82). Obesity was the strongest mediator in both genders (proportion of mediation: 11.6% in men and 23.9% in women), and its association with education was positive in men (β[SE] 0.0387 [0.0037]) and negative in women (β[SE] -0.0824 [0.0030]). Taken together, all behavioral factors explained 12.4% of the excess risk of diabetes in men and 33.3% in women. CONCLUSIONS In a general Chinese population, the association between education level and diabetes was positive in men but negative in women. Obesity was the major mediator underlying the education disparities of diabetes risk, with a stronger mediation effect among women.
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Affiliation(s)
- Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanan Huo
- Jiangxi Provincial People's Hospital Affiliated to Nanchang UniversityNanchangChina
| | - Qin Wan
- The Affiliated Hospital of Luzhou Medical CollegeLuzhouChina
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical UniversityGuiyangChina
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Li Yan
- Sun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xulei Tang
- The First Hospital of Lanzhou UniversityLanzhouChina
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical UniversityFuzhouChina
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical UniversityDalianChina
| | - Guixia Wang
- The First Hospital of Jilin UniversityChangchunChina
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Li Chen
- Qilu Hospital of Shandong UniversityJinanChina
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading DistrictShanghaiChina
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western MedicineNanjingChina
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Shengli Wu
- Karamay Municipal People's HospitalXinjiangChina
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lulu Chen
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Tianshu Zeng
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Jiajun Zhao
- Shandong Provincial Hospital affiliated to Shandong UniversityJinanChina
| | - Yiming Mu
- Chinese People's Liberation Army General HospitalBeijingChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Bouclaous C, Azar LJ, Barmo N, Daher R, Tabaja J, El Hout G, Berika L. Levels and Correlates of Numeracy Skills in Lebanese Adults with Diabetes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10557. [PMID: 36078271 PMCID: PMC9517913 DOI: 10.3390/ijerph191710557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Diabetes numeracy skills are required in the interpretation of food labels, insulin pump dosage, the interpretation of blood glucose meter data, and the determination of carbohydrate intake. This study assessed the levels and correlates of numeracy skills in Lebanese adults with diabetes to identify those most at risk of uncontrolled diabetes. In total, 299 adults with diabetes, mean age 47.4 ± 19.8 years, took the questionnaire. It consisted of self-developed items on sociodemographic and health-related factors, in addition to the Diabetes Numeracy Test-15 (DNT-15) and the Single Item Literacy Screener. Many participants (62%) scored < 10 on the DNT-15 indicating insufficient numeracy skills. DNT-15 scores were positively associated with literacy, exercise, healthy diet, perceived diabetes control, frequency of glycaemia measurement, ability to afford treatment, and ease of understanding information related to diabetes. Age, BMI, and complications were negatively correlated with DNT-15 score. Numeracy skills were higher in males, single individuals, and in people with type 1 diabetes, fewer complications, controlled HbA1c, higher income, higher education, a prior visit to a dietician, and ability to maintain personal care despite COVID-19. Interventions to strengthen numeracy skills would empower individuals with diabetes, lead to appropriate self-management behaviors, and prevent health complications in at-risk individuals.
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Affiliation(s)
- Carmel Bouclaous
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 36, Lebanon
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17
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Zhang J, Chen Z, Pärna K, van Zon SKR, Snieder H, Thio CHL. Mediators of the association between educational attainment and type 2 diabetes mellitus: a two-step multivariable Mendelian randomisation study. Diabetologia 2022; 65:1364-1374. [PMID: 35482055 PMCID: PMC9283137 DOI: 10.1007/s00125-022-05705-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/15/2022] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes mellitus is a major health burden disproportionately affecting those with lower educational attainment (EA). We aimed to obtain causal estimates of the association between EA and type 2 diabetes and to quantify mediating effects of known modifiable risk factors. METHODS We applied two-step, two-sample multivariable Mendelian randomisation (MR) techniques using SNPs as genetic instruments for exposure and mediators, thereby minimising bias due to confounding and reverse causation. We leveraged summary data on genome-wide association studies for EA, proposed mediators (i.e. BMI, blood pressure, smoking, television watching) and type 2 diabetes. The total effect of EA on type 2 diabetes was decomposed into a direct effect and indirect effects through multiple mediators. Additionally, traditional mediation analysis was performed in a subset of the National Health and Nutrition Examination Survey 2013-2014. RESULTS EA was inversely associated with type 2 diabetes (OR 0.53 for each 4.2 years of schooling; 95% CI 0.49, 0.56). Individually, the largest contributors were BMI (51.18% mediation; 95% CI 46.39%, 55.98%) and television watching (50.79% mediation; 95% CI 19.42%, 82.15%). Combined, the mediators explained 83.93% (95% CI 70.51%, 96.78%) of the EA-type 2 diabetes association. Traditional analysis yielded smaller effects but showed consistent direction and priority ranking of mediators. CONCLUSIONS/INTERPRETATION These results support a potentially causal protective effect of EA against type 2 diabetes, with considerable mediation by a number of modifiable risk factors. Interventions on these factors thus have the potential of substantially reducing the burden of type 2 diabetes attributable to low EA.
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Affiliation(s)
- Jia Zhang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Zekai Chen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Katri Pärna
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Sander K R van Zon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harold Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chris H L Thio
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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18
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Having Type 2 Diabetes Does Not Imply Retirement before Age 65 in Europe. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-020-09306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Na-Ek N, Srithong J, Aonkhum A, Boonsom S, Charoen P, Demakakos P. Educational level as a cause of type 2 diabetes mellitus: Caution from triangulation of observational and genetic evidence. Acta Diabetol 2022; 59:127-135. [PMID: 34514530 PMCID: PMC8968222 DOI: 10.1007/s00592-021-01795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED BACKGROUND AND OBJECTIVE: Education might be causal to type 2 diabetes mellitus (T2DM). We triangulated cohort and genetic evidence to consolidate the causality between education and T2DM. METHODS We obtained observational evidence from the English Longitudinal Study of Ageing (ELSA). Self-reporting educational attainment was categorised as high (post-secondary and higher), middle (secondary), and low (below secondary or no academic qualifications) in 6,786 community-dwelling individuals aged ≥ 50 years without diabetes at ELSA wave 2, who were followed until wave 8 for the first diabetes diagnosis. Additionally, we performed two-sample Mendelian randomisation (MR) using an inverse-variance weighted (IVW), MR-Egger, weighted median (WM), and weighted mode-based estimate (WMBE) method. Steiger filtering was further applied to exclude single-nucleotide polymorphisms (SNPs) that were correlated with an outcome (T2DM) stronger than exposure (education attainment). RESULTS We observed 598 new diabetes cases after 10.4 years of follow-up. The adjusted hazard ratios (95% CI) of T2DM were 1.20 (0.97-1.49) and 1.58 (1.28-1.96) in the middle- and low-education groups, respectively, compared to the high-education group. Low education was also associated with increased glycated haemoglobin levels. Psychosocial resources, occupation, and health behaviours fully explained these inverse associations. In the MR analysis of 210 SNPs (R2 = 0.0161), the odds ratio of having T2DM per standard deviation-decreasing years (4.2 years) of schooling was 1.33 (1.01-1.75; IVW), 1.23 (0.37-4.17; MR-Egger), 1.56 (1.09-2.27; WM), and 2.94 (0.98-9.09; WMBE). However, applying Steiger filtering attenuated most MR results towards the null. CONCLUSIONS Our inconsistent findings between cohort and genetic evidence did not support the causality between education and T2DM.
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Affiliation(s)
- Nat Na-Ek
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand.
- Unit of Excellence On Research in Health Outcomes and Patient Safety in Elderly (U-R-HOPE), School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand.
| | - Juthamanee Srithong
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Authakorn Aonkhum
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Suthida Boonsom
- Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
- Unit of Excellence On Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Researches (UPPER), School of Pharmaceutical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Pimphen Charoen
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, 10400, Thailand
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
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Excess Heritability Contribution of Alcohol Consumption Variants in the "Missing Heritability" of Type 2 Diabetes Mellitus. Int J Mol Sci 2021; 22:ijms222212318. [PMID: 34830198 PMCID: PMC8623960 DOI: 10.3390/ijms222212318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 12/04/2022] Open
Abstract
We aim to compare the relative heritability contributed by variants of behavior-related environmental phenotypes and elucidate the role of these factors in the conundrum of “missing heritability” of type 2 diabetes. Methods: We used Linkage-Disequilibrium Adjusted Kinships (LDAK) and LDAK-Thin models to calculate the relative heritability of each variant and compare the relative heritability for each phenotype. Biological analysis was carried out for the phenotype whose variants made a significant contribution. Potential hub genes were prioritized based on topological parameters of the protein-protein interaction network. We included 16 behavior-related phenotypes and 2607 valid variants. In the LDAK model, we found the variants of alcohol consumption and caffeine intake were identified as contributing higher relative heritability than that of the random variants. Compared with the relative expected heritability contributed by the variants associated with type 2 diabetes, the relative expected heritability contributed by the variants associated with these two phenotypes was higher. In the LDAK-Thin model, the relative heritability of variants of 11 phenotypes was statistically higher than random variants. Biological function analysis showed the same distributions among type 2 diabetes and alcohol consumption. We eventually screened out 31 hub genes interacting intensively, four of which were validated and showed the upregulated expression pattern in blood samples seen in type 2 diabetes cases. Conclusion: We found that alcohol consumption contributed higher relative heritability. Hub genes may influence the onset of type 2 diabetes by a mediating effect or a pleiotropic effect. Our results provide new insight to reveal the role of behavior-related factors in the conundrum of “missing heritability” of type 2 diabetes.
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Lin Y, Zhang S, Wang S, Zhong X, Li Y, Xiong Z, Sun X, Huang Y, Fan Y, Guo Y, Zhou H, Yang D, Liu M, Xu X, Zhuang X, Liao X. Behavioral Factors Mediating the Impact of Educational Attainment on Incident Heart Failure - A Mediation Analysis. Circ J 2021; 85:1545-1552. [PMID: 34135264 DOI: 10.1253/circj.cj-21-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To examine the association of low educational attainment with incident heart failure (HF) and explore potential behavioral mediators of the causal pathway. METHODS AND RESULTS A total of 12,109 participants in the Atherosclerosis Risk in Communities Study (ARIC) were included. Educational attainment was measured at baseline, and the risk of HF across educational attainment groups was assessed by Cox proportional hazards models. Using mediation analysis, we evaluated the mediating role of behavioral factors in the causal pathway between educational attainment and HF. During a median follow-up of 25.1 years, 2,407 cases (19.9%) of HF occurred. Educational attainment showed an inverse association with HF risk (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1,26-1.57 for low educational attainment; HR, 1.13; 95% CI, 1.02-1.25 for medium educational attainment). In the mediation analysis, the association between educational attainment and HF was partially mediated by income, waist-to-hip ratio, current smoking, body mass index, current drinking, sports and physical activity, which explained 24.3%, 20.2%, 13.8%, 10.1%, 7.7%, 7.3% and 4.5%, respectively, of the relationship. In total, all mediators contributed 56.3% of the total effect. CONCLUSIONS Low educational attainment was associated with increased risk for HF. Income, obesity and current smoking mediated a great proportion of the total effect of educational attainment on HF. Our results provide underlying insights for the development of targeted public health interventions to reduce educational disparities on HF incidence.
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Affiliation(s)
- Yifen Lin
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Shuyi Wang
- Department of Rheumatology, First Affiliated Hospital of Sun Yat-Sen University
| | - Xiangbin Zhong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yuqi Li
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xiuting Sun
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yongqiang Fan
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Huimin Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Menghui Liu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xingfeng Xu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
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22
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Rodríguez López S, Bilal U, Ortigoza AF, Diez-Roux AV. Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005-2013). BMC Public Health 2021; 21:1572. [PMID: 34416876 PMCID: PMC8379776 DOI: 10.1186/s12889-021-11617-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity. METHODS We used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005-2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity. RESULTS In both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity. CONCLUSION Increasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CIECS, CONICET y UNC), Córdoba, Argentina
- Cátedra de Antropología, Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba (FCEFyN – UNC), Córdoba, Argentina
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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23
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Honnudóttir V, Hansen L, Veyhe AS, Andersen I, Weihe P, Strøm M, Mohr M. Social inequality in type 2 diabetes mellitus in the Faroe Islands: a cross-sectional study. Scand J Public Health 2021; 50:638-645. [PMID: 34058890 DOI: 10.1177/14034948211013267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aims: The Faroe Islands is considered a homogeneous society and has a low Gini coefficient, but the knowledge about the social distribution of health and disease is sparse. In a large population-based sample we investigated: (a) the association between socioeconomic position defined by level of education and the prevalence of type 2 diabetes mellitus by self-report in the Faroe Islands; and (b) to what degree lifestyle factors mediate the association. Methods: We used cross-sectional data from the population-based Public Health Survey Faroes 2015 (n=1095). We present odds ratios for type 2 diabetes mellitus by socioeconomic position from logistic regression models. In our main model we adjusted for potential confounders and in a secondary model we additionally adjusted for potential mediating lifestyle factors. Results: Individuals with middle and low levels of education display higher odds ratios of type 2 diabetes mellitus of 2.80 (95% confidence interval 1.32-5.92) and 4.65 (95% confidence interval 1.93-11.17) in adjusted analysis, respectively, compared to their counterparts with high education. After adjustment for potentially mediating lifestyle factors the estimates were attenuated slightly, but a significant statistical association remained, with lifestyle-related mediating factors in total explaining 21% for middle education and 34% for low education participants. Conclusions: Our results demonstrate that there may be a social gradient in the distribution of type 2 diabetes mellitus in the Faroe Islands, and that the association is partly mediated by lifestyle factors.
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Affiliation(s)
| | - Louise Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Sofía Veyhe
- Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pál Weihe
- Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Marin Strøm
- Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Magni Mohr
- Faroese Board of Public Health, Tórshavn, Faroe Islands.,Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Pertiwi P, Perwitasari DA, Satibi S. Validation of Finnish Diabetes Risk Score Indonesia Version in Yogyakarta. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i1.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetes mellitus (DM) has developed as a major public health problem in the world. It is estimated that around 50% of diabetics have not been diagnosed in Indonesia, and only two-thirds of those diagnosed are undergoing treatment. This condition must be prevented. The purpose of this study is to determine the validity and reliability of the Indonesian version of FINDRISC as an instrument for predicting type 2 diabetes mellitus (T2DM). This study was an observational study with a cross-sectional design on 60 research subjects who are indigenous people of Yogyakarta who live in Yogyakarta, which can be proven by Identity Cards by the inclusion and exclusion criteria. Validity is tested by the validity of criteria by type while using the area under the receiver-operating curve (ROC-AUC), while reliability is tested by internal consistency using Cronbach's Alpha (α). The results showed that as many as 14 people, or 23.33% experienced uncontrolled fasting blood sugar and 15 people had a risk score of FINDRISC more than 10. Based on the ROC AUC analysis, the value of 0.935 (95% CI 0.865 1.00) with a cut-off point of 10 with the value of Sn = 85%, Sp = 95%, PPV = 85%, NPV = 95%, +LR = 5.66, and -LR = 0.15. Based on the reliability test, the Cronbach's value of 0.727 is obtained. The FINDRISC questionnaire is categorized as valid and reliable so that it can be a screening tool for understanding.
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25
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AlShahrani MS. Prevalence of obesity and overweight among type 2 diabetic patients in Bisha, Saudi Arabia. J Family Med Prim Care 2021; 10:143-148. [PMID: 34017717 PMCID: PMC8132811 DOI: 10.4103/jfmpc.jfmpc_1349_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/13/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
Context: Obesity is a significant worldwide public health issue and one of the significant risk factors for type 2 diabetes and cardiovascular diseases. Aims: This study aims to determine the prevalence of obesity and overweight among type 2 diabetic patients, and explore the association between Body Mass Index (BMI), social demographics and time since diagnosis. Settings and Design: This study followed a cross-sectional study design in Bisha, Saudi Arabia. Methods and Material: Participants were identified by convenience sampling from 6 Primary Health Care Centers (PHCC) over a period of two weeks from March 16 to March 28, 2020. Statistical Analysis Used: Frequency and percentage were used to report the obesity prevalence. Chi-Square test was used to test the association between social demographics and time since diagnosis with BMI. Results: Obesity and overweight prevalence was 85.8% (n = 525), among which 27.9% (n = 171) were overweight, 57.8% were obese (n = 354), and only 13.2% (n = 81) had normal weight. A statistically significant difference between BMI and age was observed (P = 0.01). Differences between BMI and time since obesity diagnosis were statistically significant (P < 0.0001). Differences between BMI and time since type 2 diabetes diagnosis were not found to be statistically significant. Conclusion: There is a high prevalence of obesity and overweight among type 2 diabetic patients in Bisha. Differences in BMI were found to be statistically significant according to age, gender, education level and time since obesity diagnosis. Patient education programs and public health awareness about diabetes and obesity are highly recommended.
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Affiliation(s)
- Mohammad S AlShahrani
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia
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26
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Joint effect of high blood pressure and physical inactive on diabetes mellitus: a population-based cross-sectional survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E614-E620. [PMID: 33628968 PMCID: PMC7888404 DOI: 10.15167/2421-4248/jpmh2020.61.4.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
Introduction The relationship of high blood pressure and physical inactivity to diabetes mellitus is well known, but not many studies have known the joint effect of the two in causing diabetes mellitus. This study aims to evaluate the joint effect of high blood pressure and less physical activity against Diabetes Mellitus (DM) in Indonesia. Methods This is a cross-sectional study. Subjects in this study were the age group ≥ 21 years old who were followed by the interview. We investigated factors related to DM in Indonesia associated with blood pressure and physical activity by controlling other confounding variables. Statistical analyses were conducted using logistic regression. Age, sex, education level, marital status, occupation, body mass index, residence area, stress, fruit, and vegetable consumption were adjusted for in the multivariate model. Results The prevalence of DM was 3.86% among respondents. Multivariate analysis showed that people who had hypertension and less physical activity had a risk of 3.68 (95% CI, 2.43-5.34) times having DM. People who had hypertension and enough physical activity had a risk of 2.33 (95% CI, 1.65-6.43) times having DM. While people who do not have hypertension and had less physical activity had a risk of 1.81 (95% CI, 1.34-3.62) times. Conclusions People with hypertension and less physical activity have the greatest risk of developing DM.
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Paudel S, Tran T, Owen AJ, Smith BJ. The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis. Nutr Metab Cardiovasc Dis 2020; 30:1758-1767. [PMID: 32636120 DOI: 10.1016/j.numecd.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS AND RESULTS This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. CONCLUSION Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.
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Affiliation(s)
- Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Mathisen J, Jensen AKG, Andersen I, Andersen GS, Hvidtfeldt UA, Rod NH. Education and incident type 2 diabetes: quantifying the impact of differential exposure and susceptibility to being overweight or obese. Diabetologia 2020; 63:1764-1774. [PMID: 32361776 DOI: 10.1007/s00125-020-05150-3] [Citation(s) in RCA: 4] [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: 09/19/2019] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS Educational inequality in type 2 diabetes incidence is evident in many high-income countries. Previous studies have shown that differential exposure to being overweight/obese across educational groups may partly explain this inequality. Whether differential susceptibility to being overweight/obese across educational groups contributes to this inequality has been investigated less frequently, even though it is a plausible mechanism. The two mechanisms may even be highly intertwined. In this longitudinal cohort study, we investigated the simultaneous contribution of differential exposure and differential susceptibility to being overweight/obese to educational inequality in type 2 diabetes incidence. METHODS The study population comprised 53,159 Danish men and women aged 50-64 years at baseline who were followed for a mean of 14.7 years. We estimated rate differences of type 2 diabetes by education level per 100,000 person-years. Using counterfactual mediation analysis, these rate differences were decomposed into proportions attributable to differential exposure, differential susceptibility and all other pathways, respectively. We compared this approach with conventional approaches to mediation and interaction analysis. RESULTS Compared with a high level of education, a low education level was associated with 454 (95% CI 398, 510) additional cases of type 2 diabetes, and a medium education level with 316 (CI 268, 363) additional cases. Differential exposure to being overweight/obese accounted for 37% (CI 31%, 45%) of the additional cases among those with a low education level and 29% (CI 24%, 36%) of the additional cases among those with a medium education level. Differential susceptibility accounted for 9% (CI 4%, 14%) and 6% (CI 3%, 10%) of the additional cases among those with a low and medium education level, respectively. Compared with the counterfactual approach, the conventional approaches suggested stronger effects of both mechanisms. CONCLUSIONS/INTERPRETATION Differential exposure and susceptibility to being overweight/obese are both important mechanisms in the association between education and type 2 diabetes incidence.
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Affiliation(s)
- Jimmi Mathisen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353, Copenhagen, Denmark.
| | - Aksel K G Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353, Copenhagen, Denmark
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Odoi EW, Nagle N, Zaretzki R, Jordan M, DuClos C, Kintziger KW. Sociodemographic Determinants of Acute Myocardial Infarction Hospitalization Risks in Florida. J Am Heart Assoc 2020; 9:e012712. [PMID: 32427043 PMCID: PMC7428988 DOI: 10.1161/jaha.119.012712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Identifying social determinants of myocardial infarction (MI) hospitalizations is crucial for reducing/eliminating health disparities. Therefore, our objectives were to identify sociodemographic determinants of MI hospitalization risks and to assess if the impacts of these determinants vary by geographic location in Florida. Methods and Results This is a retrospective ecologic study at the county level. We obtained data for principal and secondary MI hospitalizations for Florida residents for the 2005-2014 period and calculated age- and sex-adjusted MI hospitalization risks. We used a multivariable negative binomial model to identify sociodemographic determinants of MI hospitalization risks and a geographically weighted negative binomial model to assess if the strength of associations vary by location. There were 645 935 MI hospitalizations (median age, 72 years; 58.1%, men; 73.9%, white). Age- and sex-adjusted risks ranged from 18.49 to 69.48 cases/10 000 persons, and they were significantly higher in counties with low education levels (risk ratio [RR]=1.033, P<0.0001) and high divorce rate (RR, 0.995; P=0.018). However, they were significantly lower in counties with high proportions of rural (RR, 0.996; P<0.0001), black (RR, 1.026; P=0.032), and uninsured populations (RR, 0.983; P=0.040). Associations of MI hospitalization risks with education level and uninsured rate varied geographically (P for non-stationarity test=0.001 and 0.043, respectively), with strongest associations in southern Florida (RR for <high school education, 1.036-1.041; RR for uninsured rate, 0.971-0.976). Conclusions Black race, divorce, rural residence, low education level, and lack of health insurance were significant determinants of MI hospitalization risks, but associations with the latter 2 were stronger in southern Florida. Thus, interventions for addressing MI hospitalization risks need to prioritize these populations and allocate resources based on empirical evidence from global and local models for maximum efficiency and effectiveness.
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Affiliation(s)
- Evah Wangui Odoi
- Comparative and Experimental Medicine College of Veterinary Medicine The University of Tennessee Knoxville TN
| | - Nicholas Nagle
- Department of Geography The University of Tennessee Knoxville TN
| | - Russell Zaretzki
- Department of Business Analytics and Statistics The University of Tennessee Knoxville TN
| | - Melissa Jordan
- Public Health Research Division of Community Health Promotion Florida Department of Health Tallahassee FL
| | - Chris DuClos
- Environmental Public Health Tracking Division of Community Health Promotion Florida Department of Health Tallahassee FL
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Diderichsen F, Andersen I, Mathisen J. How does socioeconomic development in Brazil shape social inequalities in diabetes? Glob Public Health 2020; 15:1454-1462. [PMID: 32396790 DOI: 10.1080/17441692.2020.1763419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Many countries, including Brazil, are facing growing social inequalities in diabetes prevalence. The different states in Brazil represent different levels of development and by comparing diabetes inequalities across states we aim to get a better understanding of how educational inequalities in diabetes are linked to social development. We use the latest cross-sectional national health survey of Brazil - PNS-2013 (N = 60,202) and analyse the disparities in diabetes as well as the differential exposure and susceptibility to the effect of obesity across states for men and women. Among women in high-HDI states the prevalence of diabetes is 11.7 percentage units (CI: 9.3; 14.0) higher among the lowest compared to the highest educated. In less-developed states the disparity is smaller. Among men, there is no social gradient found for diabetes, but obesity is positively associated with education. The association between obesity and diabetes is stronger among the low educated particularly for men in high-HDI states. Here the interaction effect between low education and obesity is 11.7 (CI 8.1; 15.4) percentage units. The fact that economic development is associated with increasingly unequal levels of diabetes and with unequal levels of exposure and susceptibility to obesity indicates that other interacting determinants are important for the development of the diabetes epidemic in Brazil.
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Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Fundação Oswaldo Cruz, IAM, Recife, Brazil
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Mathisen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lee PN, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence relating smoking to type 2 diabetes. World J Meta-Anal 2020; 8:119-152. [DOI: 10.13105/wjma.v8.i2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
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Sociodemographic, socioeconomic, and clinical factors associated with diabetes screening in Asian Americans. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01267-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Seiglie JA, Marcus ME, Ebert C, Prodromidis N, Geldsetzer P, Theilmann M, Agoudavi K, Andall-Brereton G, Aryal KK, Bicaba BW, Bovet P, Brian G, Dorobantu M, Gathecha G, Gurung MS, Guwatudde D, Msaidié M, Houehanou C, Houinato D, Jorgensen JMA, Kagaruki GB, Karki KB, Labadarios D, Martins JS, Mayige MT, Wong-McClure R, Mwangi JK, Mwalim O, Norov B, Quesnel-Crooks S, Silver BK, Sturua L, Tsabedze L, Wesseh CS, Stokes A, Atun R, Davies JI, Vollmer S, Bärnighausen TW, Jaacks LM, Meigs JB, Wexler DJ, Manne-Goehler J. Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries. Diabetes Care 2020; 43:767-775. [PMID: 32051243 PMCID: PMC7085810 DOI: 10.2337/dc19-1782] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1-8.0) and of undiagnosed diabetes 4.9% (4.6-5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5-8.1), lower-middle-income economies (LMIs) 7.1% (6.6-7.6), and upper-middle-income economies (UMIs) 8.2% (7.5-9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22-1.78], LMIs 1.14 [1.06-1.23], and UMIs 1.28 [1.02-1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.
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Affiliation(s)
- Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Maja-Emilia Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Cara Ebert
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Nikolaos Prodromidis
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Glennis Andall-Brereton
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | | | - Pascal Bovet
- Ministry of Health, Victoria, Republic of Seychelles
- University Center for Primary Care and Public Health, Lausanne, Switzerland
| | - Garry Brian
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mohamed Msaidié
- Comoros Ministry of Health, Solidarity, Social Cohesion and Gender, Moroni, Comoros
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | | | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Joao S Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Mary T Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong-McClure
- Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Joseph Kibachio Mwangi
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
- Faculté de médecine, Université de Genève, Geneva, Switzerland
| | - Omar Mwalim
- Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar
| | - Bolormaa Norov
- National Center for Public Health, Ulaanbaatar, Mongolia
| | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Andrew Stokes
- Center for Global Health and Development, Boston University, Boston, MA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till W Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Africa Health Research Institute, Somkhele, South Africa
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Public Health Foundation of India, New Delhi, India
| | - James B Meigs
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Diabetes-Related Attitudes of Health Care Providers in Rural Health Centers in Aklan, Philippines using the Filipino Version of Diabetes Attitude Scale (DAS-3). J ASEAN Fed Endocr Soc 2019; 34:180-188. [PMID: 33442154 PMCID: PMC7784147 DOI: 10.15605/jafes.034.02.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/18/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the beliefs and attitudes towards diabetes of rural health care providers in Aklan, Philippines using the Diabetes Attitude Scale 3 (DAS-3) and to determine factors associated with it. Methodology This is a cross-sectional analytic survey. A total of 339 health care providers were given self-administered DAS-3 questionnaires. Additional data gathered included their age, highest educational attainment, position, municipality class, diabetes as a co-morbidity, attendance to diabetes classes, and family history of diabetes. Results Rural health care providers showed an overall mean positive attitude score of 3.5 using the DAS-3 questionnaire. In decreasing order, mean scores of participants according to subscale is as follows: “Need for Special Training in Education” (4.13) >“Autonomy of diabetes for patients” (3.70) >“Psychosocial Impact of Diabetes” (3.60) >“Value of Tight Glucose Control” (3.14) and “Seriousness of Type 2 Diabetes” (3.09). Physicians have the highest mean scores consistently in all subscales compared to other health care providers. Among the different factors considered, educational attainment (p=0.005) and work position (p=<0.001) were found out to affect attitude score of health care providers. Conclusion This study has shown that the majority of the rural health care providers believe in the need for special training of healthcare providers, psychosocial impact of diabetes and patient autonomy in diabetes self-care. However, the majority still do not strongly believe in the seriousness of diabetes and the benefits of tight sugar control. Educational attainment and work position are the consistent factors that impact diabetes-related attitude; therefore, the need to strengthen continuous medical education among health care providers.
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Tsukamoto K, Cnop M, Mori D, Kume S, Anazawa T, Doi M, Chikazawa K, Matsumaru N. Future Perspectives for the Treatment of Diabetes: Importance of a Regulatory Framework. Ther Innov Regul Sci 2018; 53:535-541. [PMID: 30176740 DOI: 10.1177/2168479018795854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The number of diabetes patients is steadily increasing worldwide. Consequently, the social burden of diabetes is huge, requiring urgent countermeasures. We performed an intensive survey of antidiabetic drugs approved in Japan, the United States, and the European Union. METHODS Information about approved antidiabetic drugs was obtained by searching databases of regulatory authorities in the 3 regions. Other relevant information was also obtained from publicly available literature and documents. RESULTS No difference in the total number and types of approved drugs among the 3 regions was found (P = .173 by log-rank test). However, the numbers of approved dipeptidyl peptidase-4 and sodium-glucose cotransporter 2 inhibitors in Japan were almost double of those in the other regions. The average sample size in clinical trials used for antidiabetic drug approval in Japan (1134 patients) was much smaller than that in the other regions (P < .001 by analysis of variance repeated measures test adjusted by the Holm method). Currently, 6 drugs with known modes of action are being developed for type 1 diabetes in Japan, whereas at the end of 2016, nearly 7-fold more products with novel modes of action were in clinical development in the United States. CONCLUSION Antidiabetic drug development in Japan costs less than that in the other regions, although novel development is less active because of regulatory differences. To achieve better pharmacotherapy for diabetes, the regulatory framework requires careful consideration.
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Affiliation(s)
- Katsura Tsukamoto
- 1 Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Miriam Cnop
- 2 ULB Center for Diabetes Research, and Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daichi Mori
- 1 Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Shoen Kume
- 3 Tokyo Institute of Technology, School of Life Science and Technology, Yokohama, Japan
| | - Takayuki Anazawa
- 4 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masako Doi
- 5 Naruto Research Institute, Otsuka Pharmaceutical Factory, Inc, Tokushima, Japan
| | - Kazuhiko Chikazawa
- 6 Office of Cellular and Tissue-Based Products, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Naoki Matsumaru
- 1 Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
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