RESUMO
PURPOSE: Given the importance of family history in the early detection and prevention of type 2 diabetes, we quantified the public health impact of reported family health history on diagnosed diabetes (DD), undiagnosed diabetes (UD), and prediabetes (PD) in the United States. METHODS: We used population data from the National Health and Nutrition Examination Survey 2009-2014 to measure the association of reported family history of diabetes with DD, UD, and PD. RESULTS: Using polytomous logistic regression and multivariable adjustment, family history prevalence ratios were 4.27 (confidence interval (CI): 3.57, 5.12) for DD, 2.03 (CI: 1.56, 2.63) for UD, and 1.26 (CI: 1.09, 1.44) for PD. In the United States, we estimate that 10.1 million DD cases, 1.4 million UD cases, and 3.9 million PD cases can be attributed to having a family history of diabetes. CONCLUSION: These findings confirm that family history of diabetes has a major public health impact on diabetes in the United States. In spite of the recent interest and focus on genomics and precision medicine, family health history continues to be an integral component of public health campaigns to identify persons at high risk for developing type 2 diabetes and early detection of diabetes to prevent or delay complications.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diagnóstico Precoce , Programas de Rastreamento , Estado Pré-Diabético/diagnóstico , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Pré-Diabético/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Monitoring national trends in disparities in different diseases could provide measures to evaluate the impact of intervention programs designed to reduce health disparities. In the US, most of the reports that track health disparities provided either relative or absolute disparities or both. However, these two measures of disparities are not only different in scale and magnitude but also the temporal changes in the magnitudes of these measures can occur in opposite directions. The trends for absolute disparity and relative disparity could move in opposite directions when the prevalence of disease in the two populations being compared either increase or decline simultaneously. If the absolute disparity increases but relative disparity declines for consecutive time periods, the absolute disparity increases but relative disparity declines for the combined time periods even with a larger increase in absolute disparity during the combined time periods. Based on random increases or decreases in prevalence of disease for two population groups, there is a higher chance the trends of these two measures could move in opposite directions when the prevalence of disease for the more advantaged group is very small relative to the prevalence of disease for the more disadvantaged group. When prevalence of disease increase or decrease simultaneously for two populations, the increase or decrease in absolute disparity has to be sufficiently large enough to warrant a corresponding increase or decrease in relative disparity. When absolute disparity declines but relative disparity increases, there is some progress in reducing disparities, but the reduction in absolute disparity is not large enough to also reduce relative disparity. When evaluating interventions to reduce health disparities using these two measures, it is important to consider both absolute and relative disparities and consider all the scenarios discussed in this paper to assess the progress towards reducing or eliminating health disparities.
RESUMO
OBJECTIVES: We examined the relationship between socioeconomic position (SEP) and sensory impairment. METHODS: We used data from the 2007 to 2010 National Health Interview Surveys (n = 69 845 adults). Multivariable logistic regressions estimated odds ratios (ORs) for associations of educational attainment, occupational class, and poverty-income ratio with impaired vision or hearing. RESULTS: Nearly 20% of respondents reported sensory impairment. Each SEP indicator was negatively associated with sensory impairment. Adjusted odds of vision impairment were significantly higher for farm workers (OR = 1.41; 95% confidence interval [CI] = 1.01, 2.02), people with some college (OR = 1.29; 95% CI = 1.16, 1.44) or less than a high school diploma (OR = 1.36; 95% CI = 1.19, 1.55), and people from poor (OR = 1.35; 95% CI = 1.20, 1.52), low-income (OR = 1.28; 95% CI = 1.14, 1.43), or middle-income (OR = 1.19; 95% CI = 1.07, 1.31) families than for the highest-SEP group. Odds of hearing impairment were significantly higher for people with some college or less education than for those with a college degree or more; for service groups, farmers, and blue-collar workers than for white-collar workers; and for people in poor families. CONCLUSIONS: More research is needed to understand the SEP-sensory impairment association.
Assuntos
Transtornos da Audição/epidemiologia , Ocupações , Classe Social , Transtornos da Visão/epidemiologia , Adulto , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Sex-specific prediabetes estimates are not available for older-adult Americans. PURPOSE: To estimate prediabetes prevalence, using nationally representative data, in civilian, non-institutionalized, older U.S. adults. METHODS: Data from 7,995 participants aged ≥50 years from the 1999-2010 National Health and Nutrition Examination Surveys were analyzed in 2013. Prediabetes was defined as hemoglobin A1c=5.7%-6.4% (39-47 mmol/mol [HbA1c5.7]), fasting plasma glucose of 100-125 mg/dL (impaired fasting glucose [IFG]), or both. Crude and age-adjusted prevalences for prediabetes, HbA1c5.7, and IFG by sex and three age groups were calculated, with additional adjustment for sex, age, race/ethnicity, poverty status, education, living alone, and BMI. RESULTS: From 1999 to 2005 and 2006 to 2010, prediabetes increased for adults aged 50-64 years (38.5% [95% CI=35.3, 41.8] to 45.9% [42.3, 49.5], p=0.003) and 65-74 years (41.3% [37.2, 45.5] to 47.9% [44.5, 51.3]; p=0.016), but not significantly for adults aged ≥75 years (45.1% [95% CI=41.1, 49.1] to 48.9% [95% CI=45.2, 52.6]; p>0.05). Prediabetes increased significantly for women in the two youngest age groups, and HbA1c5.7 for both sexes (except men aged ≥75 years), but IFG remained stable for both sexes. Men had higher prevalences than women for prediabetes and IFG among adults aged 50-64 years, and for IFG among adults aged ≥75 years. Across demographic subgroups, adjusted prevalence gains for both sexes were similar and most pronounced for HbA1c5.7, virtually absent for IFG, but greater for women than men for prediabetes. CONCLUSIONS: Given the large, growing prediabetes prevalence and its anticipated burden, older adults, especially women, are likely intervention targets.
Assuntos
Estado Pré-Diabético/epidemiologia , Negro ou Afro-Americano , Distribuição por Idade , Idoso , Glicemia , Índice de Massa Corporal , Etnicidade , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Pré-Diabético/etnologia , Distribuição por Sexo , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População BrancaRESUMO
OBJECTIVES: To examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes. To inform future diabetes prevention strategies. METHODS: Data are from the Behavioral Risk Factor Surveillance System (BRFSS) 2004 and 2005 surveys, the National Diabetes Surveillance System, and the Area Resource File. Use of diabetes care services was defined by self-reported receipt of 7 preventive care services. Our study sample included 46 806 respondents with self-reported diagnosed diabetes. Multilevel models were run to assess the association between county-level characteristics and receipt of each of the 7 preventive diabetes care service after controlling for characteristics of individuals. Results were considered significant if P < .05. RESULTS: Controlling for individual-level characteristics, our analyses showed that 7 of the 8 county-level factors examined were significantly associated with use of 1 or more preventive diabetes care services. For example, people with diabetes living in a county with a high uninsurance rate were less likely to have an influenza vaccination, visit a doctor for diabetes care, have an A1c test, or a foot examination; people with diabetes living in a county with a high physician density were more likely to have an A1c test, foot examination, or an eye examination; and people with diabetes living in a county with more people with less than high-school education were less likely to have influenza vaccination, pneumococcal vaccination, or self-care education (all P < .05). CONCLUSIONS: Many of the county-level factors examined in this study were found to be significantly associated with use of preventive diabetes care services. County policy makers may need to consider local circumstances to address the disparities in use of these services.
Assuntos
Diabetes Mellitus/terapia , Serviços Preventivos de Saúde/estatística & dados numéricos , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults.
Assuntos
Envelhecimento/fisiologia , Atenção à Saúde/organização & administração , Diabetes Mellitus/epidemiologia , Saúde Pública/métodos , Idoso , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados UnidosRESUMO
PURPOSE: To examine whether socioeconomic status, as measured by educational attainment and annual household income, is associated with lifetime risk for workplace eye injury in a large US population. METHODS: In analyses of data from the Behavioral Risk Factor Surveillance System (2005-2007, N = 43,510), we used logistic regression analysis and propensity score matching to assess associations between socioeconomic measures and lifetime risk for workplace eye injury among those aged ≥50 years. RESULTS: The lifetime prevalence of self-reported workplace eye injury was significantly higher among men (13.5%) than women (2.6%) (P < 0.001). After adjusting for age, race/ethnicity, eye care insurance, health status, and risk-taking behaviors, men with less than high school education (adjusted odds ratio [OR] = 2.24, 95% CI: 1.74-2.87) or high school education (adjusted OR = 1.92, 95% CI: 1.57-2.33) were more likely to report having had a lifetime workplace eye injury than those with more than a high school education. Men with an annual household income <$15,000 were also more likely to report having had a lifetime workplace eye injury than those whose income was >$50,000 (adjusted OR = 1.44, 95% CI: 1.07-1.95). After adjusting for other factors, no statistically significant associations between education, income, and lifetime workplace eye injury were found among women. CONCLUSIONS: Socioeconomic status was associated with lifetime risk for workplace eye injury among men but not women. Greater public awareness of individual and societal impacts of workplace eye injuries, especially among socioeconomically disadvantaged men, could help support efforts to develop a coordinated prevention strategy to minimize avoidable workplace eye injuries.
Assuntos
Escolaridade , Traumatismos Oculares/epidemiologia , Renda/estatística & dados numéricos , Traumatismos Ocupacionais/epidemiologia , Local de Trabalho/estatística & dados numéricos , Distribuição por Idade , Idoso , Bases de Dados Factuais , Etnicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , National Center for Health Statistics, U.S. , Ocupações , Prevalência , Fatores de Risco , Assunção de Riscos , Gestão da Segurança , Distribuição por Sexo , Classe Social , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To examine the different dimensions of access to eye care from a public health perspective. METHODS: We substantively review the theoretical and empirical literature on access to eye care and summarize the major considerations in measuring access to eye care using a modified behavioral framework. RESULTS: We found that progress has been made, but some gaps still remain in measuring access to eye care. Most studies have focused on individual characteristics and use of eye care services. Only a very few studies have touched on contextual characteristics, such as demographic make-up of the area in which the patient lives, and their impact on the use of eye care services. Few studies have explored the linkage between the use of eye care services and outcomes or between the use of such services and patient satisfaction. CONCLUSIONS: To address a variety of demands from patients, providers, and policy makers, it is necessary to account for potential access and realized access measures. We need to adopt new methods in assessing the relationship between contextual characteristics and use of eye care services. Moreover, we need to better understand patients' satisfaction and their relationship with utilization and health outcomes.
Assuntos
Oftalmopatias/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Saúde Pública , Humanos , Seguro Saúde/estatística & dados numéricos , Estados UnidosRESUMO
Diabetes is a common and costly disease. In 2007, an estimated 24 million people in the United States had diabetes, with almost half of these being women. Diabetes increases the risk of morbidity and mortality from several conditions, including cardiovascular disease, several types of cancers, influenza and pneumococcal infection, and kidney, eye, and periodontal diseases. The aim of this study was to examine the quality of care that women with diabetes receive and to assess how receipt of some clinical preventive services and screening for common conditions associated with diabetes vary according to socioeconomic factors. Our findings indicate that use of diabetes-specific preventive care among women is low, with the youngest women (< or =45 years) and those with low educational levels being the least likely to receive the recommended services. Women with diabetes were less likely than women without diabetes to receive a Pap smear, with the oldest women (> or =65 years) being the most vulnerable. Women with diabetes who were poor and nonwhite were less likely than more affluent and white women to receive a pneumococcal vaccination. This study's findings suggest that having a chronic disease may serve as a barrier to the receipt of recommended preventive care among women. Effective interventions should be designed to meet the needs of the most vulnerable women with diabetes, in particular, those who are at the extremes of the life cycle, are poor, and have low levels of education. Programs should use a life stage approach to address the unique needs of women with diabetes.
Assuntos
Doença Crônica/prevenção & controle , Diabetes Mellitus , Testes Diagnósticos de Rotina/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Centers for Disease Control and Prevention, U.S. , Comorbidade , Assistência Odontológica/estatística & dados numéricos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevenção & controle , Feminino , Comportamentos Relacionados com a Saúde , Disparidades em Assistência à Saúde , Humanos , Pessoa de Meia-Idade , Vacinas Pneumocócicas/uso terapêutico , Qualidade da Assistência à Saúde , Fatores Socioeconômicos , Estados Unidos , United States Agency for Healthcare Research and Quality , Adulto JovemRESUMO
Population dynamics predict a drastic growth in the number of older minority women, and resultant increases in the number of fractures. Low bone mineral density (BMD) is an important risk factor for fracture. Many studies have identified the lifestyle and health-related factors that correlate with BMD in Whites. Few studies have focused on non-Whites. The objective of the current analyses is to examine the lifestyle, anthropometric and health-related factors that are correlated with BMD in a population based cohort of Caribbean women of West African ancestry. We enrolled 340 postmenopausal women residing on the Caribbean Island of Tobago. Participants completed a questionnaire and had anthropometric measures taken. Hip BMD was measured by DXA. We estimated volumetric BMD by calculating bone mineral apparent density (BMAD). BMD was >10% and >25% higher across all age groups in Tobagonian women compared to US non-Hispanic Black and White women, respectively. In multiple linear regression models, 35-36% of the variability in femoral neck and total hip BMD respectively was predicted. Each 16-kg (one standard deviation (SD)) increase in weight was associated with 5% higher BMD; and weight explained over 10% of the variability of BMD. Each 8-year (1 SD) increase in age was associated with 5% lower BMD. Current use of both thiazide diuretics and oral hypoglycemic medication were associated with 4-5% higher BMD. For femoral neck BMAD, 26% of the variability was explained by a multiple linear regression model. Current statin use was associated with 5% higher BMAD and a history of breast feeding or coronary heart disease was associated with 1-1.5% of higher BMAD. In conclusion, African Caribbean women have the highest BMD on a population level reported to date for women. This may reflect low European admixture. Correlates of BMD among Caribbean women of West African ancestry were similar to those reported for U.S. Black and White women.
Assuntos
Densidade Óssea , Pós-Menopausa , Saúde da Mulher , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
BACKGROUND: Despite consensus about the importance of measuring quality of diabetes care and the widespread use of self-reports and medical records to assess quality, little is known about the degree of agreement between these data sources. OBJECTIVES: To evaluate agreement between self-reported and medical record data on annual eye examinations and to identify factors associated with agreement. RESEARCH DESIGN AND SUBJECTS: Data from interviews and medical records were available for 8409 adults with diabetes who participated in the baseline round of the Translating Research Into Action for Diabetes (TRIAD) Study. MEASURES: Agreement between self-reports and medical records was evaluated as concordance and Cohen's kappa coefficient. RESULTS: Self-reports indicated a higher performance of annual dilated eye examinations than did medical records (75.9% vs. 38.8%). Concordance between the data sources was 57.9%. Agreement was only fair (kappa coefficient = 0.25; 95% confidence interval, 0.23-0.26). Nearly two-thirds (64.6%) of discordance was due to lack of evidence in the medical record to support self-reported performance of the procedure. After adjustment, agreement was most strongly related to health plan (chi = 977.9, df = 9; P < 0.0001), and remained significantly better for 3 of the 10 health plans (P < 0.00001) and for persons younger than 45 years of age (P = 0.00002). CONCLUSIONS: The low level of agreement between self-report and medical records suggests that many providers of diabetes care do not have easily available accurate information on the eye examination status of their patients.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Testes Diagnósticos de Rotina , Programas de Assistência Gerenciada/estatística & dados numéricos , Prontuários Médicos/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Autorrevelação , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Modelos Lineares , Masculino , Programas de Assistência Gerenciada/normas , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Medição de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: We examined the role of family history of diabetes in awareness of diabetes risk factors and engaging in health behaviors. METHODS: We conducted a cross-sectional analysis of 1122 African American adults without diabetes who were participants in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together). RESULTS: After adjustment for age, gender, income, education, body mass index, and perceived health status, African Americans with a family history of diabetes were more aware than those without such a history of several diabetes risk factors: having a family member with the disease (relative risk [RR]=1.09; 95% confidence interval [CI]=1.03, 1.15), being overweight (RR=1.12; 95% CI=1.05, 1.18), not exercising (RR=1.17; 95% CI=1.07, 1.27), and consuming energy-dense foods (RR=1.10; 95% CI=1.00, 1.17). Also, they were more likely to consume 5 or more servings of fruits and vegetables per day (RR=1.31; 95% CI=1.02, 1.66) and to have been screened for diabetes (RR=1.21; 95% CI=1.12, 1.29). CONCLUSIONS: African Americans with a family history of diabetes were more aware of diabetes risk factors and more likely to engage in certain health behaviors than were African Americans without a family history of the disease.
Assuntos
Negro ou Afro-Americano/psicologia , Diabetes Mellitus/genética , Comportamentos Relacionados com a Saúde , Negro ou Afro-Americano/genética , Índice de Massa Corporal , Estudos Transversais , Dieta , Ingestão de Energia , Exercício Físico , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de RiscosRESUMO
BACKGROUND: It is unknown whether the previously recognized disparities in cardiovascular disease (CVD) risk factors related to annual income and educational level have diminished, persisted, or worsened in recent decades. The objective of this study was to examine 31-year trends in CVD risk factors by annual income and educational levels among US adults. METHODS: Four cross-sectional national surveys were used: National Health and Nutrition Examination Survey I (1971-1974), II (1976-1980), III (1988-1994), and 1999-2002. The main outcome measure was prevalence of high cholesterol (> or =240 mg/dL [> or =6.2 mmol/L]), high blood pressure (140/90 mm Hg), smoking, and diabetes mellitus. RESULTS: Between 1971 and 2002, the prevalence of all CVD risk factors, except diabetes, decreased in all income and education groups, but there has been little reduction in income- and education-related disparities in CVD risk factors and few improvements during the past 10 years. The prevalence of high blood pressure declined by about half in all income and education groups, ranging from 30.3% to 40.6% in 1971-1974 and 16.4% in 1999-2002, with the greatest reduction among those in the lowest income quartile and those with less than a high school education (18.0 and 15.9 percentage points, respectively). High cholesterol prevalence also declined in all groups and ranged from 28.8% to 32.4% in 1971-1974 and 15.3% to 22.0% in 1999-2002, with the largest decline (15.9 percentage points) among people with the highest incomes. Education- and income-related disparities in smoking widened considerably, because there were large declines in smoking prevalence among people with high incomes and education (from about 33% in 1971-1974 to about 14%-17% in 1999-2002) but only marginal reductions among those with low incomes and education (about 6-percentage point decline). Diabetes prevalence increased most among persons with low incomes and education. CONCLUSIONS: Despite the general success in reducing CVD risk factors in the US population, not all segments of society are benefiting equally and improvements may have slowed. Education- and income-related disparities have worsened for smoking, and increases in diabetes prevalence have occurred primarily among persons with a lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target persons of lower income and education.
Assuntos
Doenças Cardiovasculares/epidemiologia , Renda , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Escolaridade , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar/epidemiologia , Classe Social , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.
Assuntos
Doenças Cardiovasculares/etnologia , Causas de Morte , Aptidão Física , Adulto , Idoso , Antropometria , População Negra/estatística & dados numéricos , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/fisiopatologia , Eletrocardiografia , Teste de Esforço/métodos , Inquéritos Epidemiológicos , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Consumo de Oxigênio , Fatores de Risco , Trinidad e Tobago/epidemiologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Diabetes-related morbidity and mortality are primarily attributable to complications such as heart disease, stroke, lower extremity amputation, kidney disease, blindness, and visual impairment, many of which potentially can be delayed or prevented. METHODS: We examined the association of diabetes self-management education (DSME) with preventive health practices and behaviors among 22,682 persons with type 2 diabetes using data from the 2001 and 2002 Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged > or = 18 years. RESULTS: Approximately 48% of all adults with type 2 diabetes had never attended a DSME course. Among both diabetic persons who used insulin and those who did not, persons who received DSME were significantly more likely than those who had not received training to be physically active, to have received an annual dilated eye exam and flu vaccine, to have received a pneumococcal vaccine, to have checked their blood sugar daily, and to have had a physician or other health professional check their feet for sores or irritations and their hemoglobin A1C level in the past year. CONCLUSIONS: These data indicate the importance of DSME in the promotion of health practices that could prevent or delay potential diabetes complications among persons with type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Educação de Pacientes como Assunto , Prevenção Primária/educação , Assunção de Riscos , Adulto , Fatores Etários , Idoso , Atitude Frente a Saúde , Automonitorização da Glicemia , Intervalos de Confiança , Estudos Transversais , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: African Americans experience high rates of obesity and other chronic diseases, which may be related, in part, to diet. However, little is known about dietary patterns in this population, particularly from population-based data sources. METHODS: A cross-sectional analysis was conducted of 2,172 African-American adults in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together). A baseline assessment was conducted using a multistaged population-based probability sample from Raleigh and Greensboro, NC. Daily fruit, vegetable and fat intake was evaluated using a modified version of the Block questionnaire, and then stratified results were analyzed by sociodemographic, health and behavior characteristics. STATA Survey commands were used to account for the complex survey design. RESULTS: Overall, a very small number of participants met national recommendations for > or = 2 servings of fruit (8%) and > or = 3 servings of vegetables (16%) per day. Many participants reported eating high-fat foods; the average daily fat intake was 86 g, and the average daily intake from saturated fat was 24 g. People with more education and higher incomes had a higher average daily fruit intake (all p < 0.05). CONCLUSIONS: The data suggest that participants' fruit, vegetable and fat intake deviated greatly from national guidelines; older people, women, participants with higher socioeconomic status and those who were physically active consumed healthier foods. These data may be useful in developing dietary and weight loss interventions for African Americans.
Assuntos
Negro ou Afro-Americano , Dieta , Gorduras na Dieta , Feminino , Frutas , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , VerdurasRESUMO
OBJECTIVE: To determine whether mental distress among diabetic persons is associated with various CVD risk factors. METHODS: Behavioral Risk Factors Surveillance System, an ongoing, statebased, random-digit-dialed telephone survey of the noninstitutionalized US adult population. RESULTS: Diabetic persons with mental distress were more likely than those without mental distress to smoke to have hypercholesterolemia and hypertension and not to engage in leisure-time physical activity. CONCLUSIONS: Mental health professionals need to be involved in the care of diabetic persons so they can recognize and treat symptoms of mental distress and participate in research to identify interventions that can reduce mental distress and reinforce healthy behaviors.
Assuntos
Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Adulto , Idoso , Depressão/diagnóstico , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Assunção de Riscos , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. METHODS: Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking Latinos. RESULTS: Latinos had lower rates of self-monitoring of blood glucose and worse glycemic control than did Whites, higher rates of foot self-care and dilated-eye examinations, and comparable rates of other processes and intermediate outcomes of care. CONCLUSIONS: Although self-management and quality of care are comparable for Latinos and Whites with diabetes, important ethnic disparities persist in the managed care settings studied.