A growing disparity in diabetes-related mortality U.S. trends, 1989-2005.
A growing disparity in diabetes-related mortality U.S. trends, 1989-2005.
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DOI：
10.1016/j.amepre.2008.09.041
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发表时间：
2009-02
影响因子：
5.5
通讯作者：
Hamman RF
中科院分区：
文献类型：
--
作者：
Miech RA;Kim J;McConnell C;Hamman RF
在过去的15年里，不同教育水平的糖尿病相关死亡的差异是扩大了，缩小了还是保持不变，这是不清楚的，这也是本研究的主题。分析还审查了按教育水平分列的教育与糖尿病相关死亡率之间可能存在的联系机制的相关趋势。分析的第一部分使用1989-2005年的美国生命统计数据计算40-64岁成人和65-79岁成人的糖尿病相关死亡率，以提供美国每年的死亡人数（分子），并从美国人口普查中提供人口规模（分母）。分析的第二部分使用1988-1994年和1999-2004年的美国国家健康和营养检查调查（NHANES）计划来检查糖尿病患病率和糖尿病相关因素的趋势。从20世纪80年代末到现在，不同教育水平的糖尿病相关死亡率的差距大幅扩大，这一总体趋势在男性、女性、黑人、白人和西班牙裔亚组中很明显。对NHANES数据的分析表明，糖尿病护理和管理的进展（如HbA 1c水平低于8%所示）对所有教育水平的人都有帮助，但对受过高等教育的人更有好处。糖尿病相关死亡率在教育水平之间的差距不断扩大，这遵循了一个经典的“早期采用”模式。糖尿病护理和自我管理的社会进步-特别是在血糖控制方面-使社会各阶层的人受益，但教育程度较高的人的改善速度更快。制定政策和干预措施，加快受教育程度较低者的步伐，是进一步降低糖尿病相关死亡率的一种有希望的方法。
Whether a disparity in diabetes-related death across education levels has widened, narrowed, or remained constant over the past 15 years is not known, and is the topic of this study. The analysis also examined concomitant trends by education levels in possible mechanisms that link education and diabetes-related mortality. The first part of the analysis calculates diabetes-related mortality rates for adults age 40-64 and adults age 65-79 using U.S. Vital Statistics from 1989-2005 to provide the number of deaths per year in the U.S. (the numerator) and also from the U.S. Census to provide the population size (the denominator). The second part of the analysis uses the U.S. National Health and Nutrition Examination Surveys (NHANES) program in 1988-1994 and 1999-2004 to examine trends in diabetes prevalence and diabetes-related factors. A disparity in diabetes-related mortality across education levels widened substantially from the late 1980s to the present, an overall trend apparent in the subgroups of men, women, Blacks, Whites, and Hispanics. Analysis of NHANES data indicated that progress in diabetes care and management (as indicated by HbA1c levels less than 8%) has helped people of all educational levels but has been of greater benefit to those with higher education. The widening disparity across education levels in diabetes-related mortality follows a classic, “early adoption” pattern. Societal advances in diabetes care and self-management – particularly in glucose control -- have benefited people in all social strata, but the pace of improvement has been quicker for people with higher educational attainment. Developing policies and interventions to speed up the pace among people with lower education represents a promising approach to reduce diabetes-related mortality further.