Health Inequalities in Diabetes Mellitus and Hypertension: A Parish Level Study in the Northern Region of Portugal

Introduction: Diabetes and hypertension are highly prevalent conditions in Portugal. Little is known about the geographical and social patterning of these diseases, which precludes the design of targeted health policies. This study aimed to measure the geographical and socioeconomic distribution of type 2 diabetes and hypertension prevalence in the population resident in the Northern region of Portugal, for the year 2013.Material and Methods: An ecological correlation study analyzed the 2,028 parishes of the region. Prevalence data were obtained from the Regional Health Administration information system. Socioeconomic data were also obtained from this administrative database and from the 2011 national census. The association between each socioeconomic indicator and age-standardized prevalence was measured using the difference in prevalence, population attributable risk, relative inequality index, and regression coefficient.Results: The prevalence of type 2 diabetes and hypertension was 6.16% and 19.35%, respectively, and varied across parishes. These prevalences were significantly associated with low educational level, low tertiary sector weight, unemployment, and low-income rate (with prevalence differences between the most and least advantaged deciles up to 1.3% and 5.3%, respectively). Socioeconomic factors accounted for up to 20% of prevalence.Discussion: This study design did not allow us to evaluate causality and it may underestimate these diseases prevalence or its association with socioeconomic factors, but its results are in line with the evidence from other countries.Conclusion: These results emphasize the socioeconomic and geographical patterning of major diseases associated with a high mortality, and the need of health policies targeting the most deprived parishes.

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Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2832 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Malik ◽

H Chen ◽

A Cooper ◽

M Gomes ◽

V Hejjaji ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Optimal Control ◽

Risk Factor ◽

Socioeconomic Factors ◽

Funding Source ◽

Risk Factor Control ◽

Cv Disease

Abstract Background In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease. Purpose To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D. Methods DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c <7%, BP <140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control. Results Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c <7%. Conclusions In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country. Proportion of patients at goal Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca

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Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes

Psychosomatic Medicine ◽

10.1097/psy.0000000000000348 ◽

2016 ◽

Vol 78 (7) ◽

pp. 851-860 ◽

Cited By ~ 9

Author(s):

Ashley E. Moncrieft ◽

Maria M. Llabre ◽

Judith Rey McCalla ◽

Miriam Gutt ◽

Armando J. Mendez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Depressive Symptoms ◽

Glycemic Control ◽

Low Income ◽

Life Style ◽

Life Style Intervention

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Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv082 ◽

2015 ◽

Vol 23 (1) ◽

pp. 12-18 ◽

Cited By ~ 46

Author(s):

Lyndsay A Nelson ◽

Shelagh A Mulvaney ◽

Tebeb Gebretsadik ◽

Yun-Xian Ho ◽

Kevin B Johnson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Depressive Symptoms ◽

Medication Adherence ◽

Health Literacy ◽

Low Income ◽

Mhealth Intervention ◽

Lower Health ◽

The Relationship ◽

Lower Health Literacy

Abstract Objective Mobile health (mHealth) interventions may improve diabetes outcomes, but require engagement. Little is known about what factors impede engagement, so the authors examined the relationship between patient factors and engagement in an mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes (T2DM). Materials and Methods Eighty patients with T2DM participated in a 3-month mHealth intervention called MEssaging for Diabetes that leveraged a mobile communications platform. Participants received daily text messages addressing and assessing medication adherence, and weekly interactive automated calls with adherence feedback and questions for problem solving. Longitudinal repeated measures analyses assessed the relationship between participants’ baseline characteristics and the probability of engaging with texts and calls. Results On average, participants responded to 84.0% of texts and participated in 57.1% of calls. Compared to Whites, non-Whites had a 63% decreased relative odds (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI], 0.19-0.73) of participating in calls. In addition, lower health literacy was associated with a decreased odds of participating in calls (AOR = 0.67, 95% CI, 0.46-0.99, P = .04), whereas older age ( Pnonlinear = .01) and more depressive symptoms (AOR = 0.62, 95% CI, 0.38-1.02, P = .059) trended toward a decreased odds of responding to texts. Conclusions Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.

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Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

10.2337/figshare.16965199 ◽

2021 ◽

Author(s):

Han Han ◽

Yaying Cao ◽

Chengwu Feng ◽

Yan Zheng ◽

Klodian Dhana ◽

...

Keyword(s):

Type 2 Diabetes ◽

Respiratory Disease ◽

Digestive Disease ◽

Diabetes Management ◽

Healthy Lifestyle ◽

Population Attributable Risk ◽

Uk Biobank ◽

All Cause Mortality ◽

Specific Mortality

<a>Objective: </a><a></a><a></a><a></a><a></a><a>To evaluate the association of a healthy lifestyle, involving seven low-risk factors mentioned in diabetes management guidelines (no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, less sedentary behavior, adequate sleep duration, and appropriate social connection), with all-cause and cause-specific mortality among individuals with type 2 diabetes.</a> Research Design and Methods: This study included 13,366 participants with baseline type 2 diabetes from the UK Biobank free of CVD or cancer. Lifestyle information was collected through a baseline questionnaire. <a>Results: During a median follow-up of 11.7 years, 1,561 deaths were documented, with 625 from cancer, 370 from CVD, 115 from respiratory disease, 81 from digestive disease, and 74 from neurodegenerative disease.</a><a> In multivariate-adjusted model, each lifestyle factor was significantly associated with all-cause mortality and hazard ratios (95% CIs) associated with the lifestyle score (scoring 6-7 vs. 0-2 unless specified) were 0.42 (0.34, 0.52) for all-cause mortality, 0.57 (0.41, 0.80) for cancer mortality, 0.35 (0.22, 0.56) for CVD mortality, 0.26 (0.10, 0.63) for respiratory mortality, and 0.28 (0.14, 0.53) for digestive mortality (scoring 5-7 vs. 0-2). In the population-attributable-risk analysis, 27.1% (95% CI: 16.1, 38.0%) death was attributable to a poor lifestyle (scoring 0-5). </a><a>The association between a healthy lifestyle and all-cause mortality was consistent, irrespective of factors reflecting diabetes severity (diabetes duration, glycemic control, diabetes-related microvascular disease, and diabetes medication)</a>. Conclusions: <a></a><a></a>A healthy lifestyle was associated with a lower risk of mortality due to all-cause, CVD, cancer, respiratory disease, and digestive disease among individuals with type 2 diabetes.

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325-OR: Genetic and Socioeconomic Factors Are Independently Associated with Type 2 Diabetes

Diabetes ◽

10.2337/db21-325-or ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 325-OR

Author(s):

SARA JANE CROMER ◽

CHIRAG M. LAKHANI ◽

JOSEP M. MERCADER ◽

TIM MAJARIAN ◽

JOSE C. FLOREZ ◽

...

Keyword(s):

Type 2 Diabetes ◽

Socioeconomic Factors

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Impact of Early Psychosocial Factors (Childhood Socioeconomic Factors and Adversities) on Future Risk of Type 2 Diabetes, Metabolic Disturbances and Obesity: A Systematic Review

Holistic Perspectives on Trauma ◽

10.1201/b18313-20 ◽

2015 ◽

pp. 315-340

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Socioeconomic Factors ◽

Psychosocial Factors ◽

Metabolic Disturbances ◽

Future Risk

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Sugar Sweetened Beverages Intake and Risk of Non-Communicable Chronic Diseases in Longitudinal Studies: A Systematic Review and Meta-Analysis with 1.5 Million Individuals

10.21203/rs.3.rs-950662/v1 ◽

2021 ◽

Author(s):

Leonardo Pozza Santos ◽

Denise Petrucci Gigante ◽

Felipe Mendes Delpino ◽

Ana Paula Maciel ◽

Renata Moraes Bielemann

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Coronary Heart Disease ◽

Heart Disease ◽

Longitudinal Studies ◽

Low Income ◽

Meta Analysis ◽

Sugar Sweetened Beverages ◽

Sweetened Beverages

Abstract This study aimed to examine longitudinal associations between sugar-sweetened beverages (SSB) intake and type 2 diabetes, obesity, coronary heart disease and stroke in adults. We performed a systematic review and meta-analysis searching for articles in the Pubmed, Lilacs, Web of Science, Cochrane, Embase, and Scopus databases. After screening of titles and abstracts, 27 longitudinal studies were included for the narrative synthesis with all of them presenting medium or high methodological quality. None of the selected studies were from low-income countries and only three were conducted in middle-income countries. Type 2 diabetes was the most investigated disease – outcome in 15 out of 27 studies. Around 80% of the studies enrolled more than 10,000 individuals in the sample, and almost half of them followed the subjects for less than 10 years. A total of 1.5 million individuals were included in the pooled analyses, and results indicated that SSB intake increased the risk of type 2 diabetes (RR = 1.20; 95%C.I. 1.13 – 1.28), obesity (RR = 1.17; 95%C.I. 1.10 – 1.25), coronary heart disease (RR = 1.15; 95%C.I. 1.06 – 1.25), and stroke (RR = 1.10; 95%C.I. 1.01 – 1.19) in adults after adjustment for all potential confounders. Our systematic review and meta-analysis demonstrated that consumption of SSB intake appears to increase the risk non-communicable chronic disease, being the strongest evidence for type 2 diabetes. Actions are needed to be taken to reduce the SSB intake and its consequences worldwide.

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Stigma as a Barrier to Participant Recruitment of Minority Populations in Diabetes Research: Viewpoint and Lessons Learned From a Randomized Control Trial of Virtual Diabetes Self-Management Education (Preprint)

10.2196/preprints.26965 ◽

2021 ◽

Author(s):

Suzanne Mitchell ◽

Alexa Bragg ◽

Ioana Moldovan ◽

Shakiyla Woods ◽

Katherine Melo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Socioeconomic Factors ◽

Management Education ◽

Lessons Learned ◽

Self Management ◽

Advisory Group ◽

Diabetes Research ◽

Phone Calls ◽

Related Stigma

BACKGROUND Background: The development of evidence-based care geared towards Black/African American and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. While sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies. OBJECTIVE Objective: We aim to share our discovery of diabetes-related stigma as an under-recognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study. METHODS Methods: Our initial recruitment plan utilized traditional strategies to recruit minority women with uncontrolled type 2 diabetes, including letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees. RESULTS Results: Utilizing a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212. CONCLUSIONS Conclusions: There is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. In order to address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it. CLINICALTRIAL NCT02726425

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