Relative Contributions of Socioeconomic, Local Environmental, Psychosocial, Lifestyle/Behavioral, Biophysiological, and Ancestral Factors to Racial/Ethnic Disparities in Type 2 Diabetes
Relative Contributions of Socioeconomic, Local Environmental, Psychosocial, Lifestyle/Behavioral, Biophysiological, and Ancestral Factors to Racial/Ethnic Disparities in Type 2 Diabetes
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DOI：
10.2337/dc15-2255
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发表时间：
2016-07-01
期刊：
影响因子：
16.2
通讯作者：
McKinlay, John B.
中科院分区：
文献类型：
--
作者：
Piccolo, Rebecca S.;Subramanian, S. V.;McKinlay, John B.
在美国，少数族裔/少数民族的2型糖尿病（T2DM）患病率高于白人。虽然已经确定了许多T2DM的独立危险因素，但这些决定因素往往被孤立地看待，而没有考虑相互竞争的危险因素的共同作用。本研究的目的是评估6个影响因素对2型糖尿病种族差异的相对贡献。研究设计和方法采用波士顿地区社区健康III调查（2010-2012）进行横断面分析，这是第三波基于人群的样本，来自马萨诸塞州波士顿的三个种族/民族（黑人、西班牙裔、白人）的男性和女性（N = 2764）。流行糖尿病的定义是自我报告T2DM，空腹血糖>125mg/dL，或HbA(1c) >= 6.5%。我们构建了结构方程模型来评估影响T2DM患病率的每个概念域的直接影响，以及它们对种族/民族-T2DM关系的间接影响。包括所有直接和间接途径。结果最终的模型表明，黑人种族和西班牙裔种族对T2DM患病率的总影响分别为38.9%和21.8%，由社会经济、环境、社会心理和生活方式/行为风险评分介导。最大的中介影响是社会经济风险评分，分别解释了黑人种族和西班牙裔种族总影响的21.8%和26.2%。结论本研究发现，社会经济因素对解释少数民族中2型糖尿病的高患病率影响最大。
OBJECTIVERacial/ethnic minorities in the U.S. have a higher prevalence of type 2 diabetes mellitus (T2DM) than white adults. While many independent risk factors for T2DM have been identified, these determinants are often viewed in isolation without considering the joint contributions of competing risk factors. The objective of this study was to assess the relative contributions of six domains of influence to racial/ethnic disparities in T2DM.RESEARCH DESIGN AND METHODSCross-sectional analyses were conducted using the Boston Area Community Health III Survey (2010-2012), the third wave of a population-based sample of men and women from three racial/ethnic groups (black, Hispanic, white) living in Boston, Massachusetts (N = 2,764). Prevalent diabetes was defined by self-report of T2DM, fasting glucose >125mg/dL, or HbA(1c) >= 6.5%. Structural equation models were constructed to evaluate the direct effects of each conceptual domain of influence on T2DM prevalence, as well as their indirect effects on the race/ethnicity-T2DM relationship. All direct and indirect pathways were included.RESULTSThe final model indicated that 38.9% and 21.8% of the total effect of black race and Hispanic ethnicity, respectively, on T2DM prevalence was mediated by the socioeconomic, environmental, psychosocial, and lifestyle/behavioral risk scores. The largest mediating influence was the socioeconomic risk score, which explained 21.8% and 26.2% of the total effect of black race and Hispanic ethnicity, respectively.CONCLUSIONSOur study found that socioeconomic factors had the greatest impact on explaining the excess prevalence of T2DM among racial/ethnic minorities.