Joint effect of race/ethnicity or location of residence and sex on low density lipoprotein-cholesterol among veterans with type 2 diabetes: a 10-year retrospective cohort study.
Joint effect of race/ethnicity or location of residence and sex on low density lipoprotein-cholesterol among veterans with type 2 diabetes: a 10-year retrospective cohort study.
复制标题
DOI：
10.1186/s12872-020-01730-8
复制
发表时间：
2020-10-15
影响因子：
2.1
通讯作者：
Gebregziabher M
中科院分区：
文献类型：
--
作者：
Weeda ER;Bishu KG;Ward R;Axon RN;Taber DJ;Gebregziabher M
心血管（CV）疾病是美国女性死亡的主要原因。农村居住和少数民族身份与CV死亡率增加单独相关。管理血脂异常对于预防CV死亡率非常重要。然而，种族/民族和居住地对血脂异常管理中性别差异的影响尚不清楚。因此，我们试图了解种族/民族和居住地对2型糖尿病（T2 D）退伍军人男性和女性之间血脂管理差异的联合影响。退伍军人健康管理局和医疗保险和医疗补助服务中心的数据用于对T2 D退伍军人进行纵向队列研究（2007-2016）。采用随机截距的混合效应logistic回归模型，对性别与低密度脂蛋白（LDL）> 100 mg/dL之间的关系及其与种族/民族和居住地之间的相互作用（调整所有测量的协变量后）进行建模。当女性和农村居住地点都存在时，它们与LDL的拮抗有害作用有关。当评价女性和几个少数种族/民族群体的联合效应时，观察到对LDL的类似拮抗有害效应。校正测量的协变量后，与城市男性相比，城市女性（OR = 2.66，95%CI 2.48-2.85）和农村女性（OR = 3.26，95%CI 2.94-3.62）LDL > 100 mg/dL的几率较高。LDL > 100 mg/dL的几率在非西班牙裔黑人（NHB）女性中最高（OR = 5.38，95%CI 4.45-6.51），其次是非西班牙裔白色（NHW）女性（OR = 2.59，95%CI 2.44-2.77）和西班牙裔女性（OR = 2.56，95%CI 1.79-3.66）。当女性和农村居住地都存在时，观察到对LDL的拮抗有害影响。在评价女性和几个少数人种/种族群体的联合效应时，也存在对LDL的这些拮抗作用。在调整重要协变量后，NHB和农村女性的LDL升高几率是NHW和城市男性的5.4倍和3.3倍。在心血管高危人群中，这些显著的效应量（即，老年T2 D患者）表明，对于属于已知面临健康差异的一个或多个群体的个体，需要采取旨在改善脂质管理的干预措施。
Cardiovascular (CV) disease is the leading cause of death among United States women. Rural residence and ethnic-minority status are individually associated with increased CV mortality. Managing dyslipidemia is important in the prevention of CV mortality. However, the impact of race/ethnicity and location of residence on sex differences in dyslipidemia management is not well understood. Therefore, we sought to understand the joint effects of race/ethnicity and location of residence on lipid management differences between veteran men and women with type 2 diabetes (T2D). Veterans Health Administration and Centers for Medicare and Medicaid Services data were used to perform a longitudinal cohort study of veterans with T2D (2007–2016). Mixed effects logistic regression with a random intercept was used to model the association between sex and low-density lipoprotein (LDL) > 100 mg/dL and its interaction with race/ethnicity and location of residence after adjusting for all measured covariates. When female sex and rural location of residence were both present, they were associated with an antagonistic harmful effect on LDL. Similar antagonistic harmful effects on LDL were observed when the joint effect of female sex and several minority race/ethnicity groups were evaluated. After adjusting for measured covariates, the odds of LDL > 100 mg/dL were higher for urban women (OR = 2.66, 95%CI 2.48–2.85) and rural women (OR = 3.26, 95%CI 2.94–3.62), compared to urban men. The odds of LDL > 100 mg/dL was the highest among non-Hispanic Black (NHB) women (OR = 5.38, 95%CI 4.45–6.51) followed by non-Hispanic White (NHW) women (OR = 2.59, 95%CI 2.44–2.77), and Hispanic women (OR = 2.56, 95%CI 1.79–3.66). Antagonistic harmful effects on LDL were observed when both female sex and rural location of residence were present. These antagonistic effects on LDL were also present when evaluating the joint effect of female sex and several minority race/ethnicity groups. Disparities were most pronounced in NHB and rural women, who had 5.4 and 3.3 times the odds of elevated LDL versus NHW and urban men after adjusting for important covariates. These striking effect sizes in a population at high cardiovascular risk (i.e., older with T2D) suggest interventions aimed at improving lipid management are needed for individuals falling into one or more groups known to face health disparities.
登录
查看更多内容
影响因子：
16.2
作者：
Cefalu, William T.;Berg, Erika Gebel;Robinson, Shamera
通讯作者：
Robinson, Shamera
影响因子：
37.8
作者：
Han, Janet K.;Yano, Elizabeth M.;Ebrahimi, Ramin
通讯作者：
Ebrahimi, Ramin
影响因子：
4.5
作者：
Quinones, Philip Andrew;Kirchberger, Inge;Meisinger, Christa
通讯作者：
Meisinger, Christa
影响因子：
24
作者：
Grundy, Scott M.;Stone, Neil J.;Wijeysundera, Duminda N.
通讯作者：
Wijeysundera, Duminda N.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN