Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus.
Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus.
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DOI：
10.1097/aog.0000000000005324
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发表时间：
2023-10-01
影响因子：
7.2
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中科院分区：
文献类型：
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与白人相比，黑人、西班牙裔、南亚和东南亚人在妊娠糖尿病后的 8 年糖尿病发病率高出 3-4 倍，部分原因是妊娠特征。评估妊娠糖尿病 (GDM) 后 2 型糖尿病的种族和民族差异，并调查基线妊娠临床和社会或结构特征作为中介因素。我们使用关联的 2009-2011 年纽约市出生和医院数据以及 2009-2017 年纽约市 A1c 登记数据对 GDM 患者进行了回顾性队列研究。我们从出生和医院记录中确定了 GDM 和妊娠特征。我们将 2 型糖尿病分类为两项糖化血红蛋白检测结果为 6.5% 或更高。我们将妊娠特征分为临床（体重指数 [BMI]、慢性高血压、妊娠期高血压、先兆子痫、早产、剖腹产、母乳喂养、巨大儿、肩难产）和社会或结构（教育、医疗补助保险、产前护理和 WIC [妇女、婴儿和儿童特殊补充营养计划] 参与）。我们使用 Cox 比例风险模型来估计种族和民族与 8 年 2 型糖尿病发病率之间的关联，并测试了妊娠特征的中介作用，另外还调整了年龄和出生地（美国出生与外国出生）。分析数据集包括 22,338 名 GDM 患者。 8 年 2 型糖尿病总体发病率为 11.7%，黑人为 18.5%，南亚和东南亚为 16.8%，西班牙裔为 14.6%，东亚和中亚为 5.5%，白人为 5.4%，调整后的风险比为 4.0 (95% CI 2.4–3.9)、2.9 (95% CI 2.4–3.3)、与白人相比，每组的得分为 3.3 (95% CI 2.7–4.2) 和 1.0 (95% CI 0.9–1.4)。与白人相比，临床和社会或结构妊娠特征解释了黑人的 9.3% 和 23.8%、西班牙裔的 31.2% 和 24.7%、南亚人和东南亚人的 7.6% 和 16.3%。教育、医疗补助保险、WIC 参与以及 BMI 和 2 型糖尿病发病率之间的关联在白人中比黑人、西班牙裔、南亚人和东南亚人更为明显。 GDM 后 2 型糖尿病中基于人口的种族和民族不平等现象十分严重。分娩时的特征部分解释了差异，为干预生命全程心脏代谢不平等创造了机会，而黑人、西班牙裔、南亚和东南亚个体的常见社会或结构指标与体重指数的弱关联表明，需要更好地了解结构性种族主义如何影响这些群体的产后心脏代谢风险。
The 8-year diabetes incidence after gestational diabetes is 3–4 times higher in Black, Hispanic, and South and Southeast Asian individuals compared with White individuals, explained partially by pregnancy characteristics. To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators. We conducted a retrospective cohort of individuals with GDM using linked 2009–2011 New York City birth and hospital data and 2009–2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born). The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4–3.9), 2.9 (95% CI 2.4–3.3), 3.3 (95% CI 2.7–4.2), and 1.0 (95% CI 0.9–1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals. Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups.
影响因子：
4.5
作者：
Li, Weixin;Kim, Chi-Son;Howell, Elizabeth A.;Janevic, Teresa;Liu, Bian;Shi, Lizheng;Li, Yan
通讯作者：
Li, Yan