Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey

Objective

To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors.

Methods

Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities.

Findings

The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence.

Conclusion

Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.     

Contributions of A1c,fasting plasma glucose,and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011–2014

Purpose

Our goal was to characterize the contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence and to characterize how those contributions differ among U.S. population subgroups.

Descriptive Epidemiology of Diabetes Prevalence and HbA1c Distributions Based on a Self-Reported Questionnaire and a Health Checkup in the JPHC Diabetes Study

Background

The present study examined the prevalence of diabetes in Japan during the late 1990s and early 2000s using the Japan Public Health Center-based Prospective Diabetes cohort. We also investigated the distributions of HbA1c values in noncompliant diabetic participants in the cohort.

Methods

A total of 28 183 registered inhabitants aged 46–75 years from 10 public health center areas were included in the initial survey. The 5-year follow-up survey included 20 129 participants. The prevalence of diabetes was estimated using both a self-reported questionnaire and laboratory measurements. Among the participants who reported the presence of diabetes on the questionnaire (self-reported diabetes), the distributions of HbA1c values were described according to their treatment status.

Results

The age-standardized prevalence of diabetes in 55- to 74-year-old adults was 8.2% at the initial survey and 10.6% at the 5-year follow-up. At the initial survey, among participants with self-reported diabetes, the mean HbA1c values in the participants who had never and who had previously received diabetes treatment were 7.01% (standard deviation [SD] 1.56%) and 6.56% (SD 1.46%), respectively. Approximately 15% of the participants who had self-reported diabetes but had never received diabetes treatment had an HbA1c ≥ 8.4%.

Conclusions

The prevalence of diabetes increased in the JPHC cohort between the late 1990s and early 2000s. A certain proportion of participants who were aware of their diabetes but were not currently receiving treatment had poor diabetic control. Efforts to promote continuous medical attendance for diabetes care may be necessary.Key words: diabetes mellitus, prevalence, self-report, HbA1c     

Peer Reviewed: Self-Rated Depression and Physician-Diagnosed Depression and Anxiety in Florida Adults: Behavioral Risk Factor Surveillance System, 2006

Introduction

Our purpose was to determine the prevalence and correlates of self-reported symptoms of depression and physician-diagnosed depression and anxiety in Florida adults by using the 2006 Florida Behavioral Risk Factor Surveillance System (BRFSS).

Methods

The BRFSS is an ongoing, state-based telephone health survey of noninstitutionalized adults that uses random-digit dialing. In 2006, an Anxiety and Depression Module was administered in Florida. Eight questions were used to examine current depression. Two additional questions assessed health care provider diagnosis of depressive and anxiety disorders. We used SUDAAN version 9.0 to evaluate the data to accommodate the complex sampling design.

Results

Approximately 9% of Florida adults experienced current depression; about 13% had had a diagnosis of depression in their lifetime and 11% had a diagnosis of anxiety in their lifetime. Approximately 44% of respondents with current depression had not had a diagnosis of depression. Current depression and lifetime diagnosis of depression and anxiety were independently associated with sociodemographic variables (being a woman, young, previously married or never married, or unemployed or unable to work), adverse health behaviors (current or former smoking, physical inactivity, or obesity), and chronic health conditions (history of a stroke, diabetes, or asthma). Although the prevalence of depression among non-Hispanic blacks and people with low education levels is higher, members of these groups are less likely than members of other sociodemographic groups to have had depression diagnosed by a physician.

Conclusion

Depression and anxiety are associated with sociodemographic disadvantages and chronic conditions and risk factors. Knowing the prevalence of depression and anxiety, both self-rated and physician-diagnosed, is useful in identifying unmet mental health needs among subpopulations.     

Peer Reviewed: Differences in Health and Health Behaviors Between State Employees and Other Employed Adults in Oregon, 2007

Introduction

Worksite health promotion and interventions have gained popularity among state agencies. We studied the health behaviors and health characteristics of adults employed in state agencies in Oregon and compared those state employees with the statewide population of employed, insured adults.

Methods

We used data from the Oregon Behavioral Risk Factor Surveillance System (BRFSS) and a modified BRFSS survey administered to state employees. State employees were compared with employed, insured BRFSS respondents in total and then separately for men and women.

Results

The prevalence of healthy weight was lower among state employees compared with the statewide population of employed, insured adults (29% vs 35%), and the prevalence of obesity was higher (35% vs 26%). State employees were also less likely to meet physical activity recommendations (44% vs 56%). Diabetes prevalence was higher among state employees (7% vs 5%), and self-reported excellent or very good health status was lower (54% vs 64%).

Conclusions

State employees differ from the statewide population of employed, insured adults on a number of health behaviors and conditions. These differences suggest obesity prevention and diabetes control as priority areas for state agency worksite interventions.     

Peer Reviewed: A New Public Health Tool for Risk Assessment of Abnormal Glucose Levels

Introduction

Self-reported prediabetes and diabetes rates underestimate true prevalence, but mass laboratory screening is generally impractical for risk assessment and surveillance. We developed the Abnormal Glucose Risk Assessment-6 (AGRA-6) tool to address this problem.

Methods

Self-report data were obtained from the 1,887 adults (18 years or older) in the National Health and Nutrition Examination Survey (NHANES) 2005-2006 with fasting plasma glucose and oral glucose tolerance tests. We created AGRA-6 models by using logistic regression. Performance was validated with NHANES 2005-2006 data by using leave-1-out cross-validation. Standard performance characteristics (sensitivity, specificity, predictive values, area under receiver-operating characteristic curves) were assessed, as was the potential efficiency of the models to reduce laboratory testing in screening efforts.

Results

Performance was good for all models under testing conditions. Use of the AGRA-6 in screening efforts could reduce laboratory testing by at least 30% when sensitivity is maximized and at least 52% when sensitivity and specificity are balanced.

Conclusion

The AGRA-6 appears to be an effective, feasible tool that uses self-reported data compatible with the Behavioral Risk Factor Surveillance System to assess population-level prevalence, identify abnormal glucose levels, optimize screening efforts, and focus interventions to reduce the prevalence of abnormal glucose levels.     

Vital Signs: Alcohol Poisoning Deaths — United States, 2010–2012

Background

Alcohol poisoning is typically caused by binge drinking at high intensity (i.e., consuming a very large amount of alcohol during an episode of binge drinking). Approximately 38 million U.S. adults report binge drinking an average of four times per month and consuming an average of eight drinks per episode.

Methods

CDC analyzed data for 2010–2012 from the National Vital Statistics System to assess average annual alcohol poisoning deaths and death rates (ICD-10 codes X45 and Y15; underlying cause of death) in the United States among persons aged ≥15 years, by sex, age group, race/ethnicity, and state.

Results

During 2010–2012, an annual average of 2,221 alcohol poisoning deaths (8.8 deaths per 1 million population) occurred among persons aged ≥15 years in the United States. Of those deaths, 1,681 (75.7%) involved adults aged 35–64 years, and 1,696 (76.4%) involved men. Although non-Hispanic whites accounted for the majority of alcohol poisoning deaths (67.5%; 1,500 deaths), the highest age-adjusted death rate was among American Indians/Alaska Natives (49.1 per 1 million). The age-adjusted rate of alcohol poisoning deaths in states ranged from 5.3 per 1 million in Alabama to 46.5 per 1 million in Alaska.

Conclusions

On average, six persons, mostly adult men, die from alcohol poisoning each day in the United States. Alcohol poisoning death rates vary substantially by state.

Implications for Public Health Practice

Evidence-based strategies for preventing excessive drinking (e.g., regulating alcohol outlet density and preventing illegal alcohol sales in retail settings) could reduce alcohol poisoning deaths by reducing the prevalence, frequency, and intensity of binge drinking.     

Obesity and diabetes in New York City, 2002 and 2004

Introduction

Obesity and diabetes have increased rapidly nationwide, yet reliable information on these disease trends in local urban settings is unavailable. We undertook this study to characterize trends in obesity and diagnosed diabetes from 2002 to 2004 among white, black, and Hispanic adult residents of New York City.

Methods

We used data from the Community Health Survey, an annual random-digit–dial telephone survey of approximately 10,000 New York City adults aged 18 years or older, and from the Behavioral Risk Factor Surveillance System, a similar nationwide survey. Main outcome measures were body mass index (BMI), calculated from self-reported height and weight, and self-reported diabetes.

Results

In 2 years, the prevalence of obesity increased 17% in New York City, from 19.5% in 2002 to 22.8% in 2004 (P < .0001). The prevalence of diagnosed diabetes also increased 17%, from 8.1% in 2002 to 9.5% in 2004 (P < .01). Nationally, the prevalence of obesity increased by 6% during this same time period (P < .05), and diabetes prevalence did not increase significantly. The median BMI among white adults in New York City was 25.1 kg/m², significantly lower than among Hispanics (26.4 kg/m²) and blacks (26.6 kg/m², P < .05). The prevalence of diabetes increased across all BMI categories.

Discussion

The rapid increase in obesity and diabetes in New York City suggests the severity of these twin epidemics and the importance of collecting and analyzing local data for local programming and policy making.     

Peer Reviewed: Lifestyle Behaviors and Physician Advice for Change Among Overweight and Obese Adults With Prediabetes and Diabetes in the United States, 2006

Introduction

The objective of this study was to examine the lifestyle behaviors of overweight and obese people with prediabetes or diabetes and to determine whether an association exists between reported behaviors and physician advice for behavior change.

Methods

This investigation included overweight and obese people (body mass index ≥25.0 kg/m²) with prediabetes and diabetes aged 40 years or older identified from the 2006 National Health Interview Survey. Respondents reported attempts to control or lose weight, reduce the amount of fat or calories in their diet, and increase physical activity. Respondents also reported receipt of a physician recommendation for behavioral change in 1 or more of these areas. Data analysis included use of logistic regression stratified by sex and prediabetes/diabetes status to model odds of behavior by physician advice.

Results

Most people reported trying to control or lose weight (prediabetes, 82%; diabetes, 75%). Fewer identified efforts to reduce the amount of fat or calories in their diet (prediabetes, 62%; diabetes, 71%) or increase physical activity (prediabetes, 53%; diabetes, 57%). Approximately one-third reported not receiving physician advice for each of these behavior changes. In logistic regression, physician advice for reducing the amount of fat or calories in the diet and increasing physical activity was generally associated with the reported corresponding behavior.

Conclusion

Many respondents reported trying to control or lose weight, but fewer reported actually reducing fat or calories in their diet or increasing physical activity. Physician advice may influence attempts at behavior change among overweight and obese patients with prediabetes and diabetes.     

Peer Reviewed: Health-Related Quality of Life Among Adults With Multiple Chronic Conditions in the United States,Behavioral Risk Factor Surveillance System, 2007

Introduction

Little is known about health-related quality of life (HRQOL) among people with multiple chronic conditions. We examined the association between the number of chronic conditions and self-reported HRQOL outcomes among adults in the United States.

Methods

We used data from the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 (n = 430,912) to compare 4 HRQOL measures for people with any of 8 chronic conditions. We also assessed the frequency of self-reported physical and mental distress and the number of days activity was limited because of chronic conditions. We estimated prevalence and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) by using survey logistic regression analyses.

Results

People with 3 or more chronic conditions had the highest risk of reporting fair or poor health compared with respondents with no chronic conditions (AOR, 8.7; 95% CI, 8.0-9.4). People with cardiovascular conditions or diabetes had higher risk of reporting poor HRQOL outcomes than those with other chronic conditions. The odds ratios for frequent physical distress were consistently higher than those for frequent mental distress and frequent activity limitations for all conditions.

Conclusion

Strategies that help clinicians to manage their patients'' chronic conditions may contribute to improved HRQOL among adults. Our findings may help to inform these strategies.     

Peer Reviewed: Prevalence of Diabetes and Impaired Fasting Glucose in Chinese Adults,China National Nutrition and Health Survey, 2002

Introduction

As a result of rapid economic development in China, the lifestyles and dietary habits of its people have been changing, and the rates of obesity, diabetes, and other chronic conditions have increased substantially. We report the prevalence of type 2 diabetes and impaired fasting glucose (IFG) and the association between diabetes and overweight and obesity in Chinese adults. We also compare the results with those from the US National Health and Nutrition Examination Survey, 1999-2002.

Methods

Data were from adults aged 20 years or older who participated in the China National Nutrition and Health Survey, 2002 (n = 47,729). Diabetes and IFG were defined by the American Diabetes Association 2009 criteria. We assessed the prevalence of diabetes, IFG, and overweight and obesity by sex, age, region of residence, and ethnicity.

Results

The prevalence of diabetes and IFG in Chinese adults was 2.7% and 4.9%, respectively. The prevalence of diabetes increased with age and body mass index. Men and women had a similar prevalence of diabetes, but men had a significantly higher prevalence of IFG. The prevalence of diabetes among Chinese who lived in urban areas was 2 to 3 times higher than the prevalence among those who lived in rural areas (3.9% for urban areas and 6.1% for large cities vs 1.9% for rural areas), and the prevalence of IFG was 1.5 to 2 times higher (6.1% and 8.1% vs 4.2%, respectively). The prevalence of diabetes among Chinese women and young (20-39 y) and middle-aged (40-59 y) adults who lived in large cities was similar to the prevalence of diabetes in the US population.

Conclusion

The prevalence of diabetes and IFG was much higher in urban than rural areas, particularly in the large cities of China. Prevention must be emphasized among adults to reduce the future social and economic burden of diabetes in China.     

Peer Reviewed: Increasing Prevalence of Gestational Diabetes and Pregnancy-Related Hypertension in Los Angeles County,California, 1991–2003

Introduction

Gestational diabetes and pregnancy-related hypertension can lead to adverse health effects in mothers and infants. We assessed recent trends in the rates of these conditions in Los Angeles County, California.

Methods

Hospital discharge data were used to identify all women aged 15–54 years who resided in the county, had a singleton delivery from 1991 through 2003, and had gestational diabetes or pregnancy-related hypertension listed as a discharge diagnosis at the time of delivery. The prevalence of each condition was calculated by calendar year, race/ethnicity, and age group. Temporal trends in the rates were assessed by using negative binomial regression models, controlling for race/ethnicity and age. Separate models were run for each racial/ethnic and age group.

Results

The age-adjusted prevalence of gestational diabetes increased more than threefold (from 14.5 cases per 1000 women in 1991 to 47.9 cases per 1000 in 2003). The age-adjusted prevalence of pregnancy-related hypertension also increased (from 40.5 cases per 1000 in 1991 to 54.4 cases per 1000 in 2003). In the multivariable regression analysis, the annual rate increase for gestational diabetes was 8.3% overall and was highest among Hispanics (9.9%). The annual rate increase for pregnancy-related hypertension was 2.8% overall and was highest among blacks (4.8%).

Conclusion

The rates of gestational diabetes and pregnancy-related hypertension are increasing in Los Angeles County. Further research is needed to determine the causes of the observed increases and the growing racial/ethnic disparities in those rates.     

Differences by sex in the prevalence of diabetes mellitus,impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis

Objective

To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa.

Methods

In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries). A random-effects model was then used to calculate and compare the odds of men and women having each condition.

Findings

In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.20–2.03), whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.72–0.98). The prevalence of diabetes mellitus – which was generally similar in both sexes (OR: 1.01; 95% CI: 0.91–1.11) – was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men.

Conclusion

Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.     

Peer Reviewed: Age and Racial/Ethnic Disparities in Prepregnancy Smoking Among Women Who Delivered Live Births

Introduction

Prenatal smoking prevalence remains high in the United States. To reduce prenatal smoking prevalence, efforts should focus on delivering evidence-based cessation interventions to women who are most likely to smoke before pregnancy. Our objective was to identify groups with the highest prepregnancy smoking prevalence by age within 6 racial/ethnic groups.

Methods

We analyzed data from 186,064 women with a recent live birth from 32 states and New York City from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum women. We calculated self-reported smoking prevalence during the 3 months before pregnancy for 6 maternal racial/ethnic groups by maternal age (18-24 y or ≥25 y). For each racial/ethnic group, we modeled the probability of smoking by age, adjusting for education, Medicaid enrollment, parity, pregnancy intention, state of residence, and year of birth.

Results

Younger women had higher prepregnancy smoking prevalence (33.2%) than older women (17.6%), overall and in all racial/ethnic groups. Smoking prevalences were higher among younger non-Hispanic whites (46.4%), younger Alaska Natives (55.6%), and younger American Indians (46.9%). After adjusting for confounders, younger non-Hispanic whites, Hispanics, Alaska Natives, and Asian/Pacific Islanders were 1.12 to 1.50 times as likely to smoke as their older counterparts.

Conclusion

Age-appropriate and culturally specific tobacco control interventions should be integrated into reproductive health settings to reach younger non-Hispanic white, Alaska Native, and American Indian women before they become pregnant.     

Peer Reviewed: Changes in Receiving Preventive Care Services Among US Adults With Diabetes, 1997-2007

Introduction

Diabetes is a chronic disease that requires complex continuing medical care and patient self-management to reduce the risk of long-term complications. Receipt of multiple recommended preventive care services can prevent or delay diabetes-related complications such as blindness and lower-extremity amputations.

Methods

We analyzed 1997 and 2007 Behavioral Risk Factor Surveillance System data to examine change in rates of adults with diabetes receiving 4 essential preventive care services (influenza and pneumococcal vaccinations and annual foot and eye examinations).

Results

The overall age-adjusted rate of receiving all 4 of the preventive care services was 10% in 1997 but increased to 20% in 2007. Rates for receiving all 4 services increased significantly in all demographic subgroups except Hispanics.

Conclusion

Use of preventive care services is increasing, but most US adults with diabetes do not meet recommendations, and the problem is particularly pronounced among Hispanics. The need to receive preventive care services should continue to be emphasized in clinical and community settings to increase the percentage of adults with diabetes who receive them.     

Chronic Liver Disease-Associated Hospitalizations Among Adults with Diabetes,National Inpatient Sample, 2001–2012

Objective

Many people with diabetes have a variety of diabetes-related complications. Among the variety of conditions associated with diabetes, however, liver diseases are less well recognized. As such, we aimed to describe chronic liver disease (CLD)-associated hospitalization rates among U.S. adults with diabetes from 2001–2012.

Methods

We used a nationally representative database of hospitalizations, the National Inpatient Sample, to determine CLD-associated hospitalization rates among U.S. adults aged ≥18 years with and without diabetes, from 2001–2012. Hospitalizations listing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for CLD on the discharge record were selected for analysis and were further classified by diabetes status based on concurrent presence of a diabetes ICD-9-CM code. We calculated average annual age-adjusted hospitalization rates and 95% confidence intervals (CIs), and conducted a test for trend.

Results

For 2001–2012, the total age-adjusted CLD-associated hospitalization rate among adults with diabetes (1,680.9 per 100,000 population; 95% CI 1,577.2, 1,784.6) was approximately four times the rate of adults without diabetes (424.2 per 100,000 population; 95% CI 413.4, 435.1). Total age-adjusted hospitalization rates of adults with and without diabetes increased 59% and 48%, respectively, from 2001–2002 to 2011–2012 (p<0.001). Hepatitis C- and chronic hepatitis and cirrhosis-associated hospitalizations comprised the largest proportion of total CLD-associated hospitalizations among adults with and without diabetes.

Conclusion

Providers should be aware of the potential existence of CLD among adults with diabetes and counsel patients on preventive methods to avoid progressive liver damage.Approximately 11% of U.S. adults, or 25.6 million people, have diabetes mellitus. Diagnosed diabetes accounts for 73% of all cases of diabetes.¹ The number of Americans diagnosed with diabetes has more than tripled over the years, from approximately 6 million in 1980 to 21 million in 2011.² Type 2 diabetes, usually beginning with insulin resistance, comprises 90% to 95% of diagnosed diabetes cases among adults.¹ Insulin resistance and type 2 diabetes are associated with chronic liver disease (CLD), which has also increased in prevalence among U.S. adults, from 12% during 1988–1994 to 15% during 2005–2008.³ The spectrum of CLD associated with diabetes includes nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, and viral hepatitis.^3–15Despite the increasing prevalence of both type 2 diabetes and CLD and the wide spectrum of CLD associated with diabetes, few studies have explored CLD-associated hospitalizations among adults with diabetes. We used hospital discharge data from the 2001–2012 National Inpatient Sample (NIS) to estimate CLD-associated hospitalizations among adults aged ≥18 years with and without diabetes.¹⁶     

Dynapenic Obesity and Prevalence of Type 2 Diabetes in Middle-Aged Japanese Men

Background

The independent and combined associations of muscle strength and obesity on the prevalence of type 2 diabetes in Japanese men remain unclear.

Methods

Hand grip strength was cross-sectionally evaluated between 2011 and 2013 to assess muscle strength in 5039 male workers aged 40 to 64 years. Weight and height were measured, and overweight/obesity was defined as a body mass index ≥25 kg/m². The prevalence of type 2 diabetes, defined as fasting plasma glucose ≥126 mg/dL and/or hemoglobin A1c ≥6.5% and/or self-reported physician-diagnosed diabetes, was evaluated. Odds ratios (OR) and 95% confidence intervals (95% CI) for the prevalence of type 2 diabetes were obtained using a logistic regression model.

Results

In total, 611 participants had type 2 diabetes, and 1763 participants were overweight/obese. After adjustment for covariates, we found an inverse association between muscle strength and the prevalence of type 2 diabetes (P for trend <0.01). In addition, when the analyses were stratified by obesity status, the multivariable-adjusted OR per 2-standard-deviation increase in muscle strength was 0.64 (95% CI, 0.49–0.83) in the overweight/obese group, compared to a weaker relationship in the normal-weight group (OR 0.79 per 2-standard-deviation increase; 95% CI, 0.60–1.06).

Conclusions

Dynapenia, an age-related decrease in muscle strength, is associated with increased prevalence of type 2 diabetes, and this relationship is stronger in overweight/obese middle-aged Japanese men than in normal-weight men.Key words: muscle strength, hand strength, body mass index, hyperglycemia, dynapenia     

Peer Reviewed: Racial/Ethnic and Socioeconomic Disparities in Health-Related Quality of Life Among People With Coronary Heart Disease, 2007

Introduction

Health-related quality of life (HRQOL) refers to a person''s or group''s perceived physical and mental health over time. Coronary heart disease (CHD) affects HRQOL and likely varies among groups. This study examined disparities in HRQOL among adults with self-reported CHD.

Methods

We examined disparities in HRQOL by using the unhealthy days measurements among adults who self-reported CHD in the 2007 Behavioral Risk Factor Surveillance System state-based telephone survey. CHD was based on self-reported medical history of heart attack, angina, or coronary heart disease. We assessed differences in fair/poor health status, 14 or more physically unhealthy days, 14 or more mentally unhealthy days, 14 or more total unhealthy days (total of physically and mentally unhealthy days), and 14 or more activity-limited days. Multivariate logistic regression models included age, race/ethnicity, sex, education, annual household income, household size, and health insurance coverage.

Results

Of the population surveyed, 35,378 (6.1%) self-reported CHD. Compared with non-Hispanic whites, Native Americans were more likely to report fair/poor health status (adjusted odds ratio [AOR], 1.7), 14 or more total unhealthy days (AOR, 1.6), 14 or more physically unhealthy days (AOR, 1.7), and 14 or more activity-limited days (AOR, 1.9). Hispanics were more likely than non-Hispanic whites to report fair/poor health status (AOR, 1.5) and less likely to report 14 or more activity-limited days (AOR, 0.5), and Asians were less likely to report 14 or more activity-limited days (AOR, 0.2). Non-Hispanic blacks did not differ in unhealthy days measurements from non-Hispanic whites. The proportion reporting 14 or more total unhealthy days increased with increasing age, was higher among women than men, and was lower with increasing levels of education and income.

Conclusion

There are sex, racial/ethnic, and socioeconomic disparities in HRQOL among people with CHD. Tailoring interventions to people who have both with CHD and poor HRQOL may assist in the overall management of CHD.