Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study.
Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study.
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糖尿病患者健康行为的教育差异：将研究转化为糖尿病行动（TRIAD）研究。
DOI：
10.1186/1471-2458-7-308
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发表时间：
2007-10-29
影响因子：
4.5
通讯作者：
Ettner SL
中科院分区：
文献类型：
--
作者：
Karter AJ;Stevens MR;Brown AF;Duru OK;Gregg EW;Gary TL;Beckles GL;Tseng CW;Marrero DG;Waitzfelder B;Herman WH;Piette JD;Safford MM;Ettner SL
我们对糖尿病相关健康行为的社会差异的理解是不完整的。这项研究的目的是确定教育程度较低是否与较差的糖尿病相关健康行为有关。这项观察性研究是基于来自约180，000名糖尿病患者的8，763名调查受访者的队列，这些患者接受来自美国10个管理式医疗保健计划的68个提供者团体的护理。自我报告的调查数据包括个人教育程度（“教育”）和五个糖尿病自我护理行为的个人中的行为将明确指出：足部检查（在有周围神经病变症状或足部溃疡病史的患者中）;自我监测血糖（SMBG;仅胰岛素使用者）;吸烟;运动;以及某些糖尿病相关的健康寻求行为（过去12个月内使用糖尿病健康教育、网站或支持小组）。预测概率建模在每个层次的自我报告的教育程度，使用分层逻辑回归模型与随机效应的聚类内的健康计划。受教育程度较低的患者不吸烟、定期锻炼和寻求健康行为的预测概率显著较低，而SMBG和足部自我检查并不因受教育程度而异。对患者因素的广泛调整显示，对估计值或其显著性没有明显的混杂影响，大多数教育-行为关系在性别、种族和其他患者特征之间相似。教育和吸烟之间的关系在不同年龄段有很大差异，在25-44岁的人中有很强的反比关系，在45-64岁的人中适度，但在65岁以上的人中不明显。疾病管理的健康计划和供应商的沟通强度并没有改变检查的教育行为的关系。其他衡量社会经济地位的指标也得出了类似的结果。受教育程度与健康行为之间的关系在大多数行为中是适度的。在整个生命过程中，受教育程度较低的患者减少多种自我护理行为的累积效应可能在塑造社会健康梯度方面发挥重要作用。
Our understanding of social disparities in diabetes-related health behaviors is incomplete. The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors. This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States. Self-reported survey data included individual educational attainment ("education") and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated: foot exams (among those with symptoms of peripheral neuropathy or a history of foot ulcers); self-monitoring of blood glucose (SMBG; among insulin users only); smoking; exercise; and certain diabetes-related health seeking behaviors (use of diabetes health education, website, or support group in last 12 months). Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with random effects for clustering within health plans. Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors, while SMBG and foot self-examination did not vary by education. Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance, and most education-behavior relationships were similar across sex, race and other patient characteristics. The relationship between education and smoking varied significantly across age, with a strong inverse relationship in those aged 25–44, modest for those ages 45–64, but non-evident for those over 65. Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships. Other measures of socioeconomic position yielded similar findings. The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient.
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影响因子：
16.2
作者：
Al-Delaimy, WK;Willett, WC;Hu, FB
通讯作者：
Hu, FB
影响因子：
3
作者：
Duru, O. Kenrik;Mangione, Carol M.;Brown, Arleen F.
通讯作者：
Brown, Arleen F.
影响因子：
5.4
作者：
Lynch, JW;Kaplan, GA;Salonen, JT
通讯作者：
Salonen, JT
影响因子：
--
作者：
Al-Delaimy, WK;Manson, JE;Hu, FB
通讯作者：
Hu, FB
影响因子：
39.2
作者：
Mangione, Carol M.;Gerzoff, Robert B.;Selby, Joe V.
通讯作者：
Selby, Joe V.