Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study
Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study
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DOI：
10.1016/j.diabres.2016.09.007
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发表时间：
2016-11-01
影响因子：
5.1
通讯作者：
Jaime Miranda, J.
中科院分区：
文献类型：
--
作者：
Bernabe-Ortiz, Antonio;Carrillo-Larco, Rodrigo M.;Jaime Miranda, J.
背景：本研究的目的是估计秘鲁不同城市化程度和海拔的四种环境中 T2D 的发病率和危险因素。方法：在秘鲁城市、城乡结合部和农村地区进行前瞻性队列研究。从最新的人口普查中抽取了按年龄和性别分层的参与者随机样本。 T2D定义为空腹血糖≥7.0mmol/L或正在服用抗糖尿病药物。暴露分为两组：地理变量（城市化和海拔）和可改变的风险因素。估计了发生率、相对风险 (RR)、95% 置信区间 (95%CI) 和人群归因分数 (PAF)。 结果：分析了 3135 名参与者的数据，其中 48.8% 为男性，平均年龄 55.6 岁。 T2D 总体基线患病率为 7.1%（95% CI 6.2-8.0%）。在随访中，包括 6207 人年的随访，总共增加了 121 例新发 T2D 病例，相当于每 100 人年的发病率为 1.95 (95% CI 1.63-2.33)。 T2D 发病率不存在城乡梯度；然而，与海平面地区相比，生活在高海拔地区的参与者糖尿病发病率更高（RR = 1.58；95% CI 1.01-2.48）。肥胖是发生 T2D 的最高归因风险，但结果因环境而异，根据城市化和海拔高度的不同，从 14% 到 80% 不等。 结论：我们的结果表明，高海拔地区 T2D 的发病率更高。新发糖尿病病例很大程度上归因于肥胖，但肥胖的贡献因环境而异。这些发现可以为降低糖尿病发病率的适当具体策略提供参考。 (C) 2016 年作者。由爱思唯尔爱尔兰有限公司出版
Background: The study aims were to estimate the incidence and risk factors for T2D in four settings with different degree of urbanization and altitude in Peru.Methods: Prospective cohort study conducted in urban, semi-urban, and rural areas in Peru. An age-and sex-stratified random sample of participants was taken from the most updated census. T2D was defined as fasting blood glucose >= 7.0 mmol/L or taking anti-diabetes medication. Exposures were divided into two groups: geographical variables (urbanization and altitude), and modifiable risk factors. Incidence, relative risks (RR), 95% confidence intervals (95%CI), and population attributable fractions (PAF) were estimated.Results: Data from 3135 participants, 48.8% males, mean age 55.6 years, was analyzed. Overall baseline prevalence of T2D was 7.1% (95% CI 6.2-8.0%). At follow-up, including 6207 person-years of follow-up, a total of 121 new T2D cases were accrued, equating to an incidence of 1.95 (95% CI 1.63-2.33) per 100 person-years. There was no urban to rural gradient in the T2D incidence; however, compared to sea level sites, participants living in high altitude had a higher incidence of diabetes (RR = 1.58; 95% CI 1.01-2.48). Obesity had the highest attributable risk for developing T2D, although results varied by setting, ranging from 14% to 80% depending on urbanization and altitude.Conclusions: Our results suggest that the incidence of T2D was greater in high altitude sites. New cases of diabetes were largely attributed to obesity, but with substantial variation in the contribution of obesity depending on the environment. These findings can inform appropriate context-specific strategies to reduce the incidence of diabetes. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.