Relationship between housing insecurity, diabetes processes of care, and self-care behaviors

Background The aim of this analysis was to examine the influence of housing insecurity on diabetes processes of care and self-care behaviors and determine if that relationship varied by employment status or race/ethnicity. Methods Using nationally representative data from the Behavioral Risk Factor Surveillance System (2014-2015), 16,091 individuals were analyzed for the cross-sectional study. Housing insecurity was defined as how often respondents reported being worried or stressed about having enough money to pay rent/mortgage. Following unadjusted logistic models testing interactions between housing insecurity and either employment or race/ethnicity on diabetes processes of care and self-care behaviors, stratified models were adjusted for demographics, socioeconomic status, health insurance status, and comorbidity count. Results 38.1% of adults with diabetes reported housing insecurity. Those reporting housing insecurity who were employed were less likely to have a physicians visit (0.58, 95%CI 0.37,0.92), A1c check (0.45, 95%CI 0.26,0.78), and eye exam (0.61, 95%CI 0.44,0.83), while unemployed individuals were less likely to have a flu vaccine (0.84, 95%CI 0.70,0.99). Housing insecure White adults were less likely to receive an eye exam (0.67, 95%CI 0.54,0.83), flu vaccine (0.84, 95%CI 0.71,0.99) or engage in physical activity (0.82, 95%CI 0.69,0.96), while housing insecure Non-Hispanic Black adults were less likely to have a physicians visit (0.56, 95%CI 0.32,0.99). Conclusions Housing insecurity had an influence on diabetes processes of care and self-care behaviors, and this relationship varied by employment status and race/ethnicity. Diabetes interventions should incorporate discussion surrounding housing insecurity and consider differences in the impact by demographic factors on diabetes care.

Associations between sarcopenia with asthmatic prevalence, lung function and comorbidity

Background Sarcopenia was listed as a treatment trait in behavioral/risk factors of severe asthma, but studies between asthma and sarcopenia were scant. This study plans to determine the associations between sarcopenia with asthmatic prevalence, symptoms, lung function and comorbidity. Methods 15404 individuals from the China Health and Retirement Longitudinal Study(CHARLS) and 10263 individuals from Study on global AGEing and adult health(SAGE) in China were included in this study. Four components of this study were respectively used to assess bidirectional association in the prevalence between sarcopenia with asthma, and estimate the relationships between sarcopenia with asthmatic symptoms, lung function and comorbidity via generalized additive models. The 10-item Center for Epidemiological Studies–Depression Scale≥12 scores was classified as depression in CHARLS. Results In CHARLS and SAGE, the prevalence of sarcopenia in asthmatics was higher than those without asthma. Asthmatics with sarcopenia had a significantly increased prevalence of severe shortness of breath(sarcopenia yes vs no, adjusted OR=3.71, 95%CI: 1.43-9.60) and airway obstruction in SAGE(sarcopenia yes vs no, adjusted OR=6.82, 95%CI: 2.54-18.34) and an obvious reduction of PEF in CHARLS and SAGE(sarcopenia yes vs no, adjusted RR=0.86, 95%CI: 0.82-0.91) compared to asthmatics without sacropenia. The presence of sarcopenia was positively associated with the prevalence of chronic obstructive pulmonary disease(sarcopenia yes vs no, adjusted OR=5.76, 95%CI:2.01-16.5) and depression(sarcopenia yes vs no, adjusted OR=1.87, 95%CI:1.11-3.14) in asthmatics. Conclusions Our findings indicated that sarcopenia partakes in the development of asthma by affecting lung function and comorbidity and maybe considered a treatable trait of asthma management.

Factors Determining the Three-Year Dynamics of Lipid Metabolism Indicators in Residents of a Large Industrial Region of Siberia

Aim. To assess the contribution of traditional and socio-economic factors to the development and dynamics of dyslipidemia based on the results of an epidemiological study in a large region of Siberia.Material and methods. Clinical and epidemiological prospective study of the population 35-70 years old was carried out. At the basic stage, 1600 participants were examined, including 1124 women and 476 men, the prospective stage included 807 respondents (the response was 84.1%). A survey was carried out to find out the state of health (presence of diseases, taking medications), socio-economic status (level of education and income, marital status) and the presence of behavioral risk factors (tobacco and alcohol use).Results. The proportion of people with hypercholesterolemia increased 1.2 times, low LDL – 1.1 times, and hypertriglyceridemia and low HDL – 1.7 times. In persons with hypertriglyceridemia, the frequency of detected obesity and hypertension decreased by 7.9% and 4.6%, respectively (p = 0.046). Obesity was associated with an increased risk of developing hypercholesterolemia (OR = 1.49, CI: 1.0-2.2), hypertriglyceridemia (OR = 2.14, CI: 1.5-3.0), high LDL cholesterol (OR = 2.16, CI: 1.3-3.6) and low HDL cholesterol (OR = 2.07, CI: 1.5-2.9). The presence of hypertension - with an increased risk of developing hypertriglyceridemia (OR = 2.19, CI: 1.5-3.1) and low HDL (OR = 2.49, CI: 1.8-3.5). Among people with low HDL levels, the number of smokers and drinkers decreased (by 7.0% and 5.7%, respectively), as well as those with obesity by 8.6%. The prevalence of dyslipidemia increased in all socioeconomic groups.Conclusion. Over 3 years of follow-up, there was a statistically significant increase in the proportion of persons with dyslipidemia in all socio-economic groups. There was a significant decrease in such risk factors as obesity, hypertension, smoking, alcohol consumption and an increase in the number of respondents taking lipid-lowering therapy.

Impact of Behavioral Risk Factors on Mortality Risk in Older Korean Women

Background: To investigate the impact of lifestyle risk factors on all-cause and cardiovascular disease (CVD) mortality in Korean women aged 60 yr and older. Methods: Data (n = 3,034) obtained from the Korean longitudinal study of aging were analyzed. Exposures included lifestyle risk factors, such as smoking, alcohol abuse, underweight/obesity, physical inactivity, and unintentional weight loss. Primary outcomes were premature deaths from specific and all-causes. Results: During 9.6±2.0 yr of follow-up, there were 628 cases (20.7%) of death from all causes, of which 137 cases (4.5%) were from CVD. Compared to zero risk factor (hazard ratio, HR=1), crude HR of all-cause mortality was 2.277 (95% confidence interval, CI, 1.712 ~ 3.030, P < 0.001) for one risk factor, 2.977 (95% CI, 2.124 ~ 4.003, P < 0.001) for two risk factors, and 5.154 (95% CI, 3.515 ~ 7.557, P < 0.001) for three or more risk factors. Compared to zero risk factor (HR=1), crude HR of CVD mortality was 2.035 (95% CI, 1.422 ~ 2.913, P < 0.001) for one risk factor, 2.468 (95% CI, 1.708 ~ 3.567, P < 0.001) for two risk factor, and 4.484 (95% CI, 2.830 ~ 7.102, P < 0.001) for three or more risk factors. Adjusted HRs of all-cause (P = 0.016) and CVD (P = 0.050) for three or more risk factors only remained significant for three or more risk factors. Conclusion: The current findings showed that individual and combined lifestyle risk factors were significantly associated with increased risks of all-cause and CVD mortality in older Korean women.

The Heart and Cannabis (THC) Cohort: Differences in Baseline Health and Behaviors by Cannabis Use

Background Evidence on the cardiovascular health effects of cannabis use is limited. We designed a prospective cohort study of older Veterans (66 to 68 years) with coronary artery disease (CAD) to understand the cardiovascular consequences of cannabis use. We describe the cohort construction, baseline characteristics, and health behaviors that were associated with smoking cannabis. Objective To understand the cardiovascular consequences of cannabis use. Design We designed a prospective cohort study of older Veterans (66 to 68 years) with CAD. Participants A total of 1,015 current cannabis smokers and 3,270 non-cannabis smokers with CAD. Main Measures Using logistic regression, we examined the association of baseline variables with smoking cannabis in the past 30 days. Results The current cannabis smokers and non-current smokers were predominantly male (97.2% vs 97.1%, p=0.96). Characteristics associated with recent cannabis use in multivariable analyses included lack of a high school education (odds ratio [OR] 2.15, 95% confidence interval [CI]: 1.10 to 4.19), financial difficulty (OR 1.47, 95% CI: 1.02 to 2.11), tobacco use (OR 3.02, 95% CI: 1.66 to 5.48), current drug use (OR 2.82, 95% CI: 1.06 to 7.46), and prior drug use (OR 2.84, 95% CI: 2.11 to 3.82). In contrast, compared to individuals with 0 to 1 comorbid conditions, those with 5 chronic conditions or more (OR 0.43, 95% CI: 0.27 to 0.70) were less likely to smoke cannabis. Conclusions In this older high-risk cohort, smoking cannabis was associated with higher social and behavioral risk, but with fewer chronic health conditions.

Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus

ObjectivesThis study aimed to determine the main barriers and reasons for non-adherence to preventive measures and treatment for type 2 diabetes mellitus among outpatients in Belarus.MethodsAn anonymous questionnaire survey was conducted with 814 adults aged 18 years and over who visited outpatient health care units and hospitals in Belarus. The questionnaire was developed to analyze the perceived barriers that limit adherence to preventive measures and treatment for type 2 diabetes.ResultsThe proportion of respondents who reported doing daily physical activity was 53.2%, and 46.6% consumed at least 400 grams of fruit and vegetables per day. Among the 42.8% of respondents with a prescribed treatment for type 2 diabetes mellitus, 50.1% sometimes forgot to take their medicine. The specific barriers to treatment most frequently identified by survey respondents were “Financial situation” (23.5% of respondents), and “Fear of side effects” (25.2%). Those for lifestyle instructions were “Insufficient knowledge” (29.3%), “Financial situation” (27.9%), and “Lack of motivation” (21.7%).ConclusionsThe study revealed that the main barriers to adherence were insufficient knowledge of diabetes and its treatment and an underestimation of the role of behavioral risk factors in health, combined with financial difficulties. We recommend that physicians should take a patient-centered approach to raising awareness of behavioral risk factors for type 2 diabetes mellitus, and suggest that the importance of adhering to preventative measures and treatment should be promoted in consultations in Belarus.

The system of indicators of behavioral risk factors in Russia at the national and regional levels

Introduction. Behavioral risk factors are associated with 47% of all-cause mortality in Russia.The goal of this study was to assess and to select the available data sources on the burden of behavioral risk factors in Russia and its regions.Methods included collection and systematization of medical, demographic and survey which reflected the burden of behavioral risk factors in Russia.Results. The spectrum of sources of the data on behavioral risk factors among adults in Russia has significantly expanded in recent years. Rosstat agency provided regional survey data on prevalence of consumption of tobacco and other nicotine-containing products, physical activity, overweight and obesity. The survey results may underestimate alcohol and tobacco consumption due to the sensitivity of these questions. Therefore, the use of morbidity and mortality data is needed well. Detailed regional data on food product consumption in Russia are available, but the list of food groups needs to be updated to reflect current scientific knowledge. At the same time, there is no monitoring of the consumption of table salt and iodine by the Russian citizens. The data from Rosstat surveys on physical activity is available by the regions, and it provides more reliable results in comparison with the reports of sports organizations. Monitoring of behavioral risk factors among children and adolescents in Russia has yet to be organized.Conclusions. A number of data sources have been identified that can be used to assess the burden of behavioral risk factors in Russia and the regions, and ways to improve such monitoring are proposed.