Health Inequality in Eight Adverse Outcomes Over a 25-Year Period in a Multi-Ethnic Population in New Zealand Population with Impaired Glucose Tolerance and/or Impaired Fasting Glucose: An Age-Period-Cohort Analysis

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2023-12-06 DOI:10.2147/clep.s433714

Zheng Wang, Dahai Yu, Uchechukwu Levi Osuagwu, Karen Pickering, John Baker, Richard Cutfield, Yamei Cai, Brandon J Orr-Walker, Gerhard Sundborn, Zhanzheng Zhao, David Simmons

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引用次数: 0

Abstract

Purpose: We aimed to examine socioeconomic inequality (SI) in cause-specific outcomes among adults with impaired glucose tolerance (IGT) and/or Impaired fasting glucose (IFG) in New Zealand (NZ) over 25 years.
Patients and Methods: A population-based open cohort was derived from Diabetes Care Support Service in NZ with national databases linkage. Patients aged ≥ 18 years with IGT and/or IFG were enrolled between 01/01/1994 and 31/07/2018 and followed up until death or 31/12/2018. Incident outcomes (all-cause, premature, cardiovascular, and cancer death; cardiovascular, myocardial infarction, stroke, heart failure, and end-stage kidney disease hospitalization) by demographic, anthropometric, socioeconomic status, clinical measurements, enrol-time-periods, and IGT/IFG were evaluated. Adjusted incidence rate ratios, absolute risk difference, and SI measurements (slope and relative index of inequality) were estimated using Age-Period-Cohort models.
Results: 29,894 patients (58.5 (SD 14.3) years mean age; 52.2% female) were enrolled with 5.6 (IQR: 4.4– 7.4) years of median follow-up. Mortality rates decreased, whereas hospitalization (except myocardial infarction) rates increased. SI was significant for each outcome. Higher mortality and hospitalization rates and worsened SI were common in men, older, the most deprived, and M&amacrori patients, as well as patients with obesity, current smoking, with both IFG and IGT, and greater metabolic derangement (higher systolic blood pressure, lipids, and HbA1c, and lower level of mean arterial pressure).
Conclusion: Enhanced management strategies are necessary for people with IGT and/or IFG to address persisting SI, especially for men, older people, current smokers, NZ European and M&amacrori patients, patients with obesity, or with any abnormal metabolic measurements.

Keywords: impaired glucose tolerance, impaired fasting glucose, New Zealand, M&amacrori, ethnic disparity, socioeconomic inequality, mortality, cardiovascular diseases, heart failure, cancer, end-stage renal disease

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25年期间，新西兰多种族人群中糖耐量受损和/或空腹血糖受损的8种不良结局的健康不平等:一项年龄-时期队列分析

目的:我们旨在研究25年来新西兰(NZ)糖耐量受损(IGT)和/或空腹血糖受损(IFG)的成人病因特异性结局中的社会经济不平等(SI)。患者和方法:一个基于人群的开放队列来源于新西兰糖尿病护理支持服务中心与国家数据库连接。年龄≥18岁的IGT和/或IFG患者在1994年1月1日至2018年7月31日期间入组，随访至死亡或2018年12月31日。事件结局(全因死亡、过早死亡、心血管死亡和癌症死亡;通过人口统计学、人体测量学、社会经济地位、临床测量、入组时间和IGT/IFG对心血管、心肌梗死、中风、心力衰竭和终末期肾病住院进行评估。使用年龄-时期-队列模型估计调整后的发病率比、绝对风险差和SI测量(斜率和相对不平等指数)。结果:29,894例患者(平均年龄58.5岁(SD 14.3);52.2%为女性)，中位随访时间为5.6年(IQR: 4.4 - 7.4)。死亡率下降，而住院率(心肌梗死除外)上升。SI对每个结果都有显著意义。较高的死亡率和住院率以及恶化的SI常见于男性、老年、最贫困和M&amacrori患者，以及肥胖、当前吸烟、IFG和IGT同时存在、代谢紊乱(收缩压、血脂和HbA1c较高，平均动脉压较低)的患者。结论:对于IGT和/或IFG患者，特别是男性、老年人、当前吸烟者、新西兰欧洲和M&amacrori患者、肥胖患者或任何代谢测量异常的患者，加强管理策略是必要的。关键词:糖耐量受损，空腹血糖受损，新西兰，M&, amacrori，种族差异，社会经济不平等，死亡率，心血管疾病，心力衰竭，癌症，终末期肾病

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.