Mechanisms of Diabetes and Diabetic Complications in a Multi-Ethnic Population

摘要 种族和少数民族人口背负着不成比例的糖尿病负担和与糖尿病相关的终身风险 美国的并发症，但对相关的风险和疾病管理挑战知之甚少 在土著夏威夷人和太平洋岛民(NHPI)人群中诊断出糖尿病和糖尿病并发症。这 与其他种族和地区相比，人口由于其构成的异质性而面临着特定的脆弱性 族裔人口；以土著(夏威夷土著)、移民(例如查莫罗人、美属萨摩亚人和 马绍尔语)和移民(如汤加、斐济和瓦努阿图)。不同的历史和经历 需要对描述他们独特的糖尿病和糖尿病的因素有文化上的胜任的理解 糖尿病并发症风险及干预目标。推动这项研究的中心问题是潜在的 低估了NHPI人群中患糖尿病的风险，并掩盖了由此产生的差异 更频繁地对较大的既定种族群体进行研究。最近对临床和人口水平数据的分析确实表明 太平洋岛民和亚洲亚群与白人、拉美裔和 非裔美国人。然而，这些流行病学研究未能捕捉到关键的社会机制 了解诊断出的糖尿病和糖尿病并发症如何在不同的人群中运作。稀缺 NHPI人群数据的缺失是解决健康差距的主要障碍，而健康差距是 实现健康公平。此应用程序将检查收集到的对受访者(N=8,661)的大型横断面调查 由国家卫生统计中心提供。夏威夷原住民和太平洋岛民国家健康访谈调查 (NHPI NHIS)是专门为衡量非制度化平民的健康和医疗保健利用而设计的 截至2014年的NHPI人口。利用这些数据，该项目将：1)描述确诊患者的患病率和分布， NHPI人群中的糖尿病和糖尿病并发症；2)决定社会人口学概况和社会 与NHPI成人中被诊断的糖尿病相关的因素，以及3)决定社会人口学概况和社会 与成年NHPI诊断的糖尿病并发症相关。这些分析将扩展我们的 人群中与糖尿病及其并发症诊断相关的关键人口学和社会因素的了解 NHPI种群。研究结果将为支持后续研究的发展提供重要的见解， 旨在减少糖尿病差异和改善的新的临床研究和文化上适当的干预措施 糖尿病在多民族人群中的后果。

ABSTRACT Racial and ethnic minority populations bear a disproportionate burden of diabetes and lifetime risk for diabetes-related complications in the United States, yet little is known about the risks and disease management challenges associated with diagnosed diabetes and diabetic complications in Native Hawaiian and Pacific Islander (NHPI) populations. This population faces specific vulnerabilities due to their heterogeneous composition when compared to other racial and ethnic populations; represented by indigenous (Native Hawaiian), migrant (e.g., Chamorro, American Samoan, and Marshallese) and immigrant (e.g., Tongan, Fijian, and Vanuatuan) components. The differing histories and experiences of these groups require a culturally competent understanding of the factors that describe their unique diabetes and diabetic complication risks and intervention targets. The central concern motivating this study is the potential underestimation of the risk of developing diabetes among NHPI groups and resulting disparities being masked by the more frequent studies of larger established racial groups. Recent analyses of clinical and population level data do show differences in elevated rates of diabetes in Pacific Islander and Asian subgroups compared to Whites, Hispanics, and African Americans. However, these epidemiological studies fail to capture the social mechanisms critical to understanding how diagnosed diabetes and diabetic complications operate in heterogeneous populations. The paucity of data on NHPI populations has represented a major barrier in addressing health disparities, which is central to achieving health equity. This application will examine a large cross-sectional survey of respondents (N=8,661) collected by the National Center for Health Statistics. The Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) was specially designed to measure the health and healthcare utilization of the civilian noninstitutionalized NHPI population as of 2014. Using these data, the project will: 1) describe the prevalence and distribution of diagnosed, diabetes and diabetic complications in NHPI populations; 2) determine the sociodemographic profile and social correlates associated with diagnosed diabetes in NHPI adults, and 3) determine the sociodemographic profile and social correlates associated with diagnosed diabetic complications in NHPI adulthood. These analyses will expand our understanding of critical demographic and social factors associated with diagnosed diabetes and diabetic complication in NHPI populations. Study findings will provide important insights to support the development of subsequent research, new clinical studies, and culturally appropriate interventions aimed at reducing diabetes disparities and improving diabetes outcomes within multi-ethnic populations.