Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors-An Endocrine Society Scientific Statement
Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors-An Endocrine Society Scientific Statement
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DOI：
10.1210/jc.2012-2043
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发表时间：
2012-09-01
影响因子：
5.8
通讯作者：
Anton, Blair
中科院分区：
文献类型：
--
作者：
Golden, Sherita Hill;Brown, Arleen;Anton, Blair
目的：其目的是提供一个学术审查的已发表的文献上的生物，临床和非临床贡献者种族/民族和性别差异内分泌疾病，并确定目前的知识差距，作为未来的研究需求的重点。参与者在发展的科学声明：内分泌学会的科学声明工作组（SSTF）选择的声明发展小组（S.H.G.）的领导人。她选择了一个由八名成员组成的写作小组，该小组具有内分泌学和健康差异方面的专业知识，并得到了该协会的批准。所有关于科学声明内容的讨论均通过电话会议或书面通信进行。没有向任何专家或同行评审提供资金，所有参与者都自愿抽出时间编写本科学声明。证据：全球疾病流行率数据的主要来源是世界卫生组织。PubMed的综合文献检索确定了U。S.基于人口的研究。结合医学主题词和关键词和短语的检索策略定义了两个概念：1）种族、民族和性别差异，包括特定人群; 2）特定的内分泌疾病或状况。检索发现了系统性综述、荟萃分析、大型队列研究和基于人群的研究，以及关注内分泌疾病患病率和差异决定因素的原始研究。写作小组的重点是在2型糖尿病和相关条件的高流行内分泌疾病的人群差异（前驱糖尿病和糖尿病并发症）、妊娠糖尿病、代谢综合征（重点是肥胖和血脂异常）、甲状腺疾病、骨质疏松症和维生素D缺乏。作者审查并综合了其专业领域的证据。最后声明纳入了对以下几个层面审查的回应：1）SSTF和宣传和公共外联核心委员会的评论; 2）理事会和内分泌学会成员提出的建议。声明中出现了几个主题，包括需要进行基础科学、基于人口的转化和卫生服务研究，以探索导致内分泌健康差异的潜在机制。与非西班牙裔白人相比，非西班牙裔黑人某些疾病的结局更差，死亡率更高，尽管这些疾病的发生率较低（例如糖尿病和骨质疏松性骨折的大血管并发症）或相似（例如甲状腺癌）。肥胖是少数人群糖尿病风险和甲状腺癌性别差异的重要因素，这表明针对减肥的人口干预措施可能会对一些内分泌疾病产生有利影响。在不同种族/民族群体中，肥胖的定义存在重要的复杂性，包括对亚裔美国人疾病风险的潜在低估和对非西班牙裔黑人女性的过度估计。应确定向心性肥胖的种族特异性临界点，以便临床医生能够充分评估代谢风险。几乎没有证据表明，遗传差异显着有助于种族/民族差异的内分泌疾病的检查。多层次的干预减少了糖尿病护理的差异，这些成功可以为其他内分泌疾病设计类似的干预措施。（临床内分泌代谢杂志97：E1579-E1639，2012）
Objective: The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs.Participants in Development of Scientific Statement: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement.Evidence: The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U. S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorderor condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders.Consensus Process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolicsyndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society.Conclusions: Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower(e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are importantimplications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overe stimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases. (J Clin Endocrinol Metab 97: E1579-E1639, 2012)