Cardiovascular risk factors among Roma and non-Roma populations in underprivileged settlements.

BACKGROUND: The 'Taking the screening tests close to the people' program offers cardiovascular screening to the inhabitants of underprivileged settlements. This study aimed to evaluate the cardiovascular risk factors of underprivileged populations, including individuals who described themselves as belonging to the Roma population. METHODS: During the program, we collected information about demographic features, lifestyle and current illnesses. A general health assessment (body weight, height, blood pressure and fasting blood glucose) and cardiovascular examination were performed. We analysed data on both Roma and non-Roma groups and used Pearson's chi-squared test and multiple logistic regression models to analyse the factors that contribute to the onset of comorbidities, with a special focus on ethnicity. RESULTS: Data from 6211 participants were processed. Based on self-reports, the non-Roma population consisted of 5352 respondents (1364 men (25.5%) and 3988 women (74.5%)), and the Roma population comprised 859 respondents (200 men (23.3%) and 659 women (76.7%)). A total of 91.2% (4849) of the non-Roma population and 92.5% (788) of the Roma population exercised less than 3 h per week (p < 0.001). Of the non-Roma population, 71.7% (3512) had a body mass index above 25 kg/m2, while the corresponding figure was 72.4% (609) in the Roma population (p = 0.709). The median body mass index was 28.0 (24.6-31.9) in the non-Roma population and 28.8 (24.5-33.0) in the Roma population (p < 0.001). The prevalence of active smokers was 28.7% (1531) in the non-Roma population and 60.3% (516) in the Roma population (p < 0.001). The prevalence of hypertension was 54.9% (2824) in the non-Roma population and 49.8% (412) in the Roma population (p < 0.001). The prevalence of diabetes was 11.5% (95) in the Roma population and 12.2% (619) in the non-Roma population (p < 0.001). CONCLUSION: We found a high prevalence of overweight and obesity, a lack of physical activity and an remarkably high smoking rate in the studied underprivileged population. Both type 2 diabetes and hypertension were more common among people living in underprivileged settlements than in the general Hungarian population. People living in underprivileged settlements need more attention in primary care.

Clinical characteristics and complication risks in data-driven clusters among Chinese community diabetes populations.

BACKGROUND: Novel diabetes phenotypes were proposed by the Europeans through cluster analysis, but Chinese community diabetes populations might exhibit different characteristics. This study aims to explore the clinical characteristics of novel diabetes subgroups under data-driven analysis in Chinese community diabetes populations. METHODS: We used K-means cluster analysis in 6369 newly diagnosed diabetic patients from eight centers of the REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study. The cluster analysis was performed based on age, body mass index, glycosylated hemoglobin, homeostatic modeled insulin resistance index, and homeostatic modeled pancreatic ß-cell functionality index. The clinical features were evaluated with the analysis of variance (ANOVA) and chi-square test. Logistic regression analysis was done to compare chronic kidney disease and cardiovascular disease risks between subgroups. RESULTS: Overall, 2063 (32.39%), 658 (10.33%), 1769 (27.78%), and 1879 (29.50%) populations were assigned to severe obesity-related and insulin-resistant diabetes (SOIRD), severe insulin-deficient diabetes (SIDD), mild age-associated diabetes mellitus (MARD), and mild insulin-deficient diabetes (MIDD) subgroups, respectively. Individuals in the MIDD subgroup had a low risk burden equivalent to prediabetes, but with reduced insulin secretion. Individuals in the SOIRD subgroup were obese, had insulin resistance, and a high prevalence of fatty liver, tumors, family history of diabetes, and tumors. Individuals in the SIDD subgroup had severe insulin deficiency, the poorest glycemic control, and the highest prevalence of dyslipidemia and diabetic nephropathy. Individuals in MARD subgroup were the oldest, had moderate metabolic dysregulation and the highest risk of cardiovascular disease. CONCLUSION: The data-driven approach to differentiating the status of new-onset diabetes in the Chinese community was feasible. Patients in different clusters presented different characteristics and risks of complications.

The Relationship Between Pre-Pandemic Comorbidities With SARS-CoV-2 Infections and Hospitalizations in Black Versus White Military Service Members: A Retrospective Study.

INTRODUCTION: Comorbidities such as hypertension, diabetes mellitus, asthma, and cardiovascular conditions have been reported to worsen the clinical progression of coronavirus disease 2019 (COVID-19) and related hospitalizations. Furthermore, the COVID-19 pandemic has disproportionately affected the historically marginalized groups, i.e., Black, Hispanic, and Asian individuals have substantially higher rates of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, COVID-19 hospitalization, and death compared to White individuals. Despite these findings in civilian populations, the impact of comorbidities and race in SARS-CoV-2 infection and COVID-19 hospitalizations in military populations is unknown. We evaluated the relationship of pre-selected pre-pandemic comorbidities and race with SARS-CoV-2 infections and COVID-19 hospitalizations in U.S. military service members (SMs). MATERIALS AND METHODS: We conducted a systematic review of Military Health System beneficiaries' records by accessing the Defense Medical Epidemiological Database. Our inclusion criteria were being an active duty SM and having at least one pre-COVID-19 pandemic comorbidity. Retired as well as uninfected healthy active duty SMs and beneficiaries were excluded from the study. A total population of 1.334 million active duty SM records was drawn from Defense Medical Epidemiological Database. The data were stratified, by race (primary outcome), as well as gender, age, and military service branches (secondary outcomes). RESULTS: We found higher trends in SARS-CoV-2 infection and COVID-19 hospitalization rates in Black compared to White SMs. This seamless inequality was also seen in other viral infections affecting SMs including human immunodeficiency virus and viral hepatitis. We hypothesized this disparity to some extent be associated with the presence of pre-pandemic comorbidities that is affecting this military subpopulation. Supporting our hypothesis, we found trends toward the higher pre-pandemic prevalence of diabetes mellitus, asthma, hypertension, and ischemic heart disease, in Black compared to White military SMs, especially in Black older male adults. CONCLUSION: Our results highlight the role of pre-pandemic comorbidities and race likely enhancing the frequency of SARS-CoV-2 infections and COVID-19 hospitalizations in military SMs. These preliminary findings underscore the need for future retrospective studies using additional Military Health System data bases reporting data on this military subpopulation, especially in the setting of future pathogens outbreaks or pandemics affecting military populations.

Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial.

BACKGROUND: Diabetes is the eighth leading cause of death in the USA. Inequities driven by structural racism and systemic oppression have led to racial/ethnic disparities in diabetes prevalence, diagnosis, and treatment. Diabetes-self management training (DSMT), remote glucose monitoring (RGM), and tailored support from a community health worker (CHW) have the potential to improve outcomes. This study will examine the implementation of these interventions in a safety-net healthcare setting. METHODS: Using implementation science and racial equity principles, this study aims to (1) evaluate the appropriateness; (2) measure fidelity; and (3) compare the effectiveness of varying the combination and sequence of three interventions. An exploratory aim will measure sustainability of intervention adherence and uptake. This mixed-methods trial employs a sequential, multiple assignment randomized trial (SMART) design, patient focus group discussions, and staff interviews. Eligible Black/Latine patients will be recruited using patient lists extracted from the electronic medical record system. After a detailed screening process, eligible patients will be invited to attend an in-person enrollment appointment. Informed consent will be obtained and patients will be randomized to either DSMT or RGM. At 6 months, patients will complete two assessments (diabetes empowerment and diabetes-related distress), and HbA1c values will be reviewed. "Responders" will be considered those who have an HbA1c that has improved by at least one percentage point. "Responders" remain in their first assigned study arm. "Nonresponders" will be randomized to either switch study arms or be paired with a CHW. At 6 months participants will complete two assessments again, and their HbA1c will be reviewed. Twelve patient focus groups, two for each intervention paths, will be conducted along with staff interviews. DISCUSSION: This study is the first, to our knowledge, that seeks to fill critical gaps in our knowledge of optimal sequence and combinations of interventions to support diabetes management among Black and Latine patients receiving care at a safety-net hospital. By achieving the study aims, we will build the evidence for optimizing equitable diabetes management and ultimately reducing racial and ethnic healthcare disparities for patients living in disinvested urban settings. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06040463. Registered on September 7, 2023.

Prevalence of diabetes among Indigenous women in Guatemala: a retrospective chart review.

OBJECTIVE: The objective of this study is to investigate the prevalence of diabetes in a clinical population of primarily Indigenous women in Guatemala. RESULTS: In a retrospective chart review of a clinical program serving 13,643 primarily Indigenous women in Guatemala, crude diabetes prevalence was 8.3% (95% Confidence Interval [CI]: 7.8 to 8.7) and age-adjusted diabetes prevalence was 7.9% (95% CI: 7.3 to 8.5). Among those with diabetes, 37.9% (95% CI: 35.1 to 40.8) of women were undiagnosed. Diabetes prevalence rose significantly with increasing age and was significantly higher among women with obesity (risk ratio: 1.4 [95% CI: 1.1 to 1.8]) and among women least likely to be in poverty (risk ratio: 2.0 [95% CI: 1.5 to 2.6]). Diabetes prevalence was significantly lower among Indigenous women (risk ratio: 0.7 [95% CI: 0.6 to 0.9]) and among women who spoke Mayan languages rather than Spanish (risk ratio: 0.7 [95% CI: 0.6 to 0.9]). There was no significant difference in diabetes prevalence between women who lived in rural settings and women who lived in urban settings.

Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations.

PURPOSE: The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes. METHODS: Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions. RESULTS: Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (ß = -5.49, SE = 0.71) and Hispanic participants (ß = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (ß = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs. CONCLUSIONS: Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations.

Prevalence of Diabetes Mellitus among Haitian Americans: A Hidden Epidemic.

The prevalence of diabetes mellitus in the Haitian American population remains an important question. A recent study revealed an alarming prevalence of 39.9%. To corroborate these data, between November 2021 and September 2023 a representative sample was collected among 401 Haitian Americans in Florida, Maryland, New Jersey, and New York. Results revealed a crude prevalence rate of 36.6% (95% CI 31.85, 41.55%). The age-adjusted prevalence was 29.7% (CI 19.71%, 39.63%). This study's prevalence is nearly double the 16.8% (Z=10.48, p<.0001) rate in non-Hispanic African Americans and nearly two and a half times the 12.0% (Z=14.99, p<.0001) rate in all Americans. The crude prevalence for undiagnosed diabetes mellitus was 13.38% (CI 10.19%, 17.14%), with 17.11% age-adjusted prevalence (CI 7.53%, 26.70%). The scope of the diabetes burden, especially the high rate of undiagnosed cases, indicates a need for better strategies for the prevention, screening, treatment, and management of diabetes among Haitian Americans.

Association between low cognitive performance and diabetes-related health indicators across racial and ethnic groups in adults with diabetes.

AIM: To examine the associations between low cognitive performance (LCP) and diabetes-related health indicators (including body mass index [BMI], HbA1c, systolic blood pressure [SBP], low-density lipoprotein [LDL] and self-reported poor physical health) and whether these associations vary across racial/ethnic subgroups. METHODS: We identified adults aged 60 years or older with self-reported diabetes from the 2011-2014 National Health and Nutrition Examination Survey. Individuals with cognitive test scores in the lowest quartile were defined as having LCP. We used regression models to measure the associations of LCP with diabetes-related biometrics (BMI, HbA1c, SBP and LDL); and self-reported poor physical health. Moreover, we explored potential variations in these associations across racial/ethnic subgroups. RESULTS: Of 873 (261 with LCP) adults with diabetes, LCP was associated with higher HbA1c, SBP and LDL (adjusted difference: 0.41%, 5.01 mmHg and 5.08 mg/dL, respectively; P < .05), and greater odds of reporting poor physical health (adjusted odds ratio: 1.59, P < .05). The association between LCP and HbA1c was consistent across racial/ethnic groups, and notably pronounced in Hispanic and Other. BMI worsened with LCP, except for non-Hispanic Black. Excluding the Other group, elevated SBP was observed in people with LCP, with Hispanic showing the most significant association. LDL levels were elevated with LCP for Hispanic and Other. Physical health worsened with LCP for both non-Hispanic Black and Hispanic. CONCLUSIONS: We quantified the association between LCP and diabetes-related health indicators. These associations were more pronounced in Hispanic and Other racial/ethnic groups.

Racial health disparities: a population-based analysis of physical activity and diabetes-related complications in Brazil.

OBJECTIVES: Racial disparity in physical activity in people with diabetes in Brazil remains scarcely investigated. We examined the association between physical activity and diabetes-related complications according to race in the Brazilian population. STUDY DESIGN: Cross-sectional. METHODS: We analyzed data from the 2019 National Health Survey, a population-based survey of Brazilian adults. We used a self-reported questionnaire to assess physical activity during commuting, leisure-time, domestic, and occupational activities. Diabetes-related complications included vision, kidney, and circulatory impairment, foot ulcers, diabetic coma, and all-cause complications. We used robust Poisson regression models with restricted cubic splines to examine the association between physical activity and diabetes-related complications. RESULTS: We included 2529 adults with diabetes (48.9% women; mean age: 53.5 ± 11.9 years). One-third experienced diabetes-related complications. Black adults performed less leisure-time and more occupational and commuting physical activity than White participants. Black participants showed a higher probability of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) compared to White participants independent of physical activity status. Only leisure-time physical activity was associated with a reduced probability of all-cause complications (PR: 0.78; 0.71, 0.86) whereas commuting and occupational physical activity were not associated with any diabetes-related complications. Physically inactive, Brown adults showed a higher probability of kidney, circulatory, vision, and all-cause complications than active, White adults. However, physical activity attenuated the probability of these complications in Brown participants. CONCLUSION: The association between physical activity and diabetes-related complications is domain-specific. We revealed a racial disparity in physical activity in people with diabetes in Brazil.

Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study.

OBJECTIVES: Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN: A simulation study. METHODS: We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS: In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS: A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.

Assessing Glycosylated Hemoglobin Thresholds for Development of Cardiovascular Disease by Racial and Ethnic Groups.

BACKGROUND: Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic-specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups. METHODS AND RESULTS: This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456-1.843]; P<0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022-1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal. CONCLUSIONS: Findings suggest that the use of race and ethnic- and sex-specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.

Living well with diabetes in Alaska.

Many people with diabetes mellitus experience minimal or no complications. Our objective was to determine the proportion of Alaska Native people who experienced four major complications or mortality and to identify factors that may be associated with these outcomes. We used records in a diabetes registry and clinical and demographic variables in our analyses. We used logistic regression and Cox Proportional Hazards models to evaluate associations of these parameters with death and complications that occurred prior to 2013. The study included 591 Alaska Native people with non-type 1 diabetes mellitus, diagnosed between 1986 and 1992. Over 60% of people in this study remained free of four major diabetes-related complications for the remainder of life or throughout the approximately 20-year study period. Lower BMI, higher age at diagnosis of diabetes, and use of at least one diabetes medication were associated with death and a composite of four complications. A majority of Alaska Native people with DM had none of four major complications over a 20-year period. Lower BMI and use of diabetes medications were associated with higher hazard for some deleterious outcomes. This suggests that goals in care of elders should be carefully individualised. In addition, we discuss several programme factors that we believe contributed to favourable outcomes.

Telemedicine for the Underserved Racial and Ethnic Minorities During COVID-19 and Beyond.

Objective: To demonstrate that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients as an extension of regular clinical services and provide continuity of care. Methods: A telehealth platform was established during COVID-19 pandemic and from numerous telehealth encounters we sampled 498 patients who received telehealth intervention over a 12-month period for specific services: Rx refill, consultation for laboratory results, wellness evaluation and education, and acute or sick visits with appropriate referrals. This telehealth platform was integrated with a remote patient monitoring system utilizing a Bluetooth-enabled glucometer for patients with diabetes compared to their abnormal baseline hemoglobin A1C (HgA1C). The Blood sugar values were recorded at predefined intervals to monitor controls for diabetes. The ethnic diversity and level of education of patients required addressing the digital divide, language interpretation, and navigation at each monitoring step. Results: This method demonstrated that a culturally and linguistically appropriate telehealth protocol can be implemented to improve the glycemic control of patients in an intervention group compared with a control group. Validation of the glycemic control was based on 70 patients identified as eligible for participation based on the inclusion criteria: a HgA1C level of 7% or higher obtained within the last 10 months. Informed consent was obtained for 42 participants based on patient participation constraints during the COVID-19 pandemic. Conclusions: We conclude that telemedicine procedures utilized for patients with little or no prior knowledge of remote self-monitoring methods can support their treatment of chronic diseases, such as diabetes. The outcomes from the implementation of telemedicine services were observed in a well-defined group of underserved racial and ethnic minority patients at our clinic. We now have a protocol to expand this to other chronic diseases and used as a regular clinical procedure.

Ethnic disparities in the prevalence of diabetes and its association with sleep disorder among older adults in rural southwest China.

OBJECTIVES: This study aimed to examine ethnic disparities in the prevalence of diabetes and its association with sleep disorders among the older adults Han and ethnic minority (Bai, Ha Ni, and Dai) population in rural southwest China. METHODS: A cross-sectional survey of 5,642 was conducted among the rural southwest population aged ≥60 years, consisting of a structured interview and measurement of fasting blood glucose, height, weight, and waist circumference. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. RESULTS: The overall prevalence of diabetes and sleep disorder was 10.2% and 40.1%, respectively. Bai participants had the highest prevalence of diabetes (15.9%) and obesity (9.9%)(P < 0.01), while Ha Ni participants had the lowest prevalence of diabetes (5.1%) and obesity (3.4%)(P < 0.01). The highest prevalence of sleep disorder (48.4%) was recorded in Bai participants, while Dai participants had the lowest prevalence of sleep disorder (25.6%)(P < 0.01). In all four studied ethnicities, females had a higher prevalence of sleep disorder than males (P < 0.01), and the prevalence of sleep disorder increased with age (P < 0.01). The results of multivariate logistic regression analysis indicated older adults with sleep disorder had a risk of developing diabetes (P < 0.05). Moreover, the higher educational level, family history of diabetes, and obesity were the main risk factors for diabetes in participants (P < 0.01). CONCLUSION: There are stark ethnic disparities in the prevalence of diabetes and sleep disorders in southwest China. Future diabetes prevention and control strategies should be tailored to address ethnicity, and improving sleep quality may reduce the prevalence of diabetes.

Disparities among ethnic groups in mortality and outcomes among adults with MASLD: A multicenter study.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and 10%-20% occurs in lean individuals. There is little data in the literature regarding outcomes in an ethnically-diverse patient populations with MASLD. Thus, we aim to investigate the natural history and ethnic disparities of MASLD patients in a diverse population, and stratified by body mass index categories. METHODS: We conducted a retrospective multicenter study on patients with MASLD at the Banner Health System from 2012 to 2022. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease, diabetes mellitus (DM), liver-related events (LREs), and cancer. We used competing risk and Cox proportional hazard regression analysis for outcome modelling. RESULTS: A total of 51 452 (cross-sectional cohort) and 37 027 (longitudinal cohort) patients were identified with 9.6% lean. The cohort was 63.33% European ancestry, 27.96% Hispanic ancestry, 3.45% African ancestry, and 2.31% Native American/Alaskan ancestry. Median follow-up was 45.8 months. After adjusting for confounders, compared to European individuals, Hispanic and Native American/Alaskan patients had higher prevalence of cirrhosis and DM, and individuals of Hispanic, African, and Native American/Alaskan ancestry had higher mortality and incidence of LREs and DM. Lean patients had higher mortality and incidence of LREs compared with non-lean patients. CONCLUSION: Native American/Alaskan, Hispanic, and African patients had higher mortality and incidence of LREs and DM compared with European patients. Further studies to explore the underlying disparities and intervention to prevent LREs in lean patients, particularly several ethnic groups, may improve clinical outcomes.

Impact of More Detailed Measures of Disease Severity on Racial Disparities in Cardiac Surgery Mortality among Native Hawaiians and Pacific Islanders.

Studies that examine racial disparities in health outcomes often include analyses that account or adjust for baseline differences in co-morbid conditions. Often, these conditions are defined as dichotomous (Yes/No) variables, and few analyses include clinical and/or laboratory data that could allow for more nuanced estimates of disease severity. However, disease severity - not just prevalence - can differ substantially by race and is an underappreciated mechanism for health disparities. Thus, relying on dichotomous disease indicators may not fully describe health disparities. This study explores the effect of substituting continuous clinical and/or laboratory data for dichotomous disease indicators on racial disparities, using data from the Queen's Medical Center's (QMC) cardiac surgery database (a subset of the national Society of Thoracic Surgeon's cardiothoracic surgery database) as an example case. Two logistic regression models predicting in-hospital mortality were constructed: (I) a baseline model including race and dichotomous (Yes/No) indicators of disease (diabetes, heart failure, liver disease, kidney disease), and (II) a more detailed model with continuous laboratory values in place of the dichotomous indicators (eg, including Hemoglobin A1c level rather than just diabetes yes/no). When only dichotomous disease indicators were used in the model, Native Hawaiian and other Pacific Islander (NHPI) race was significantly associated with in-hospital mortality (OR: 1.57[1.29,2.47], P=.04). Yet when the more specific laboratory values were included, NHPI race was no longer associated with in-hospital mortality (OR: 1.67[0.92,2.28], P=.28). Thus, researchers should be thoughtful in their choice of independent variables and understand the potential impact of how clinical measures are operationalized in their research.

The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment.

BACKGROUND: Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life. METHODS: From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis. RESULTS: (1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life." CONCLUSIONS: Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

Ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications: a population-based cohort study.

BACKGROUND: We examined ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications. METHODS: We conducted a population-based cohort study in Ontario, Canada among individuals with diabetes and matched individuals without diabetes (2002-18). We fit Cox proportional hazards models to determine the associations of age at diagnosis and ethnicity (Chinese, South Asian, general population) with cardiovascular complications. We tested for an interaction between age at diagnosis and ethnicity. RESULTS: There were 453,433 individuals with diabetes (49.7% women) and 453,433 matches. There was a significant interaction between age at diagnosis and ethnicity (P < 0.0001). Young-onset diabetes (age at diagnosis < 40) was associated with higher cardiovascular risk [hazard ratios: Chinese 4.25 (3.05-5.91), South Asian: 3.82 (3.19-4.57), General: 3.46 (3.26-3.66)] than usual-onset diabetes [age at diagnosis ≥ 40 years; Chinese: 2.22 (2.04-2.66), South Asian: 2.43 (2.22-2.66), General: 1.83 (1.81-1.86)] versus ethnicity-matched individuals. Among those with young-onset diabetes, Chinese ethnicity was associated with lower overall cardiovascular [0.44 (0.32-0.61)] but similar stroke risks versus the general population; while South Asian ethnicity was associated with lower overall cardiovascular [0.75 (0.64-0.89)] but similar coronary artery disease risks versus the general population. In usual-onset diabetes, Chinese ethnicity was associated with lower cardiovascular risk [0.44 (0.42-0.46)], while South Asian ethnicity was associated with lower cardiovascular [0.90 (0.86-0.95)] and higher coronary artery disease [1.08 (1.01-1.15)] risks versus the general population. CONCLUSIONS: There are important ethnic differences in the association between age at diagnosis and risk of cardiovascular complications.

Risk Factors Associated with Diabetes among Mexican-Origin Adults in Southern Arizona.

Diabetes is the seventh leading cause of death in the United States, and it is particularly problematic among the Latine population. This study employed multivariable logistic regression models to examine how hypertension, depression, and sociodemographics were associated with diabetes in a cross-sectional sample of Mexican-origin adults living in three counties of Southern Arizona. The overall prevalence of diabetes from this primary care sample was 39.4%. Holding covariates at fixed values, individuals having hypertension were 2.36 (95% CI: 1.15, 4.83) times more likely to have diabetes, when compared to individuals not having hypertension. The odds of having diabetes for individuals with ≥12 years of educational attainment were 0.29 (95% CI: 0.14, 0.61) times the corresponding odds of individuals with <12 years of educational attainment. For individuals with depression, the odds of having diabetes for those who were born in Mexico and had <30 years living in the US were 0.04 (95% CI: 0, 0.42) times the corresponding odds of individuals without depression and who were born in the US. Findings suggest clinical and public health systems should be aware of the potential increased risk of diabetes among Mexican-origin adults with hypertension and lower educational attainment.