Place matters: neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE)

While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n = 19,804) from the Diabetes Study of Northern California (DISTANCE) cohort study, an ethnically-stratified, random sample of members of Kaiser Permanente Northern California (KPNC), an integrated managed care consortium, with type 2 diabetes who completed a survey between 2005 and 2007 and who lived in a 19 county study area were included in the analyses. We estimated the association between a validated neighborhood deprivation index (NDI) and four cardiometabolic risk factors: body mass index (BMI = kg/m2), glycosylated hemoglobin (A1c), low density lipoproteins (LDL) and systolic blood pressure (SBP) using multi-level models. Outcomes were modeled in their continuous form and as binary indicators of poor control (severe obesity: BMI ≥35, poor glycemic control: A1c ≥9%, hypercholesterolemia: LDL ≥130 mg/dL, and hypertension: SBP ≥140 mmHg). BMI, A1c and SBP increased monotonically across quartiles of NDI (p < 0.001 in each case); however, LDL was significantly associated with NDI only when comparing the most to the least deprived quartile. NDI remained significantly associated with BMI and A1c after adjusting for individual level factors including income and education. A linear trend (p < 0.001) was observed in the relative risk ratios for dichotomous indicators of severe obesity, poor glycemic control, and 2 or more poorly controlled cardiometabolic risk factors across NDI quartile. In adjusted models, higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes. However, longitudinal data are needed to test the causal direction of these relationships.     

Risk of type 2 diabetes mellitus among adults aging with vision impairment: The role of the neighborhood environment

BackgroundVision impairment (VI) affects approximately 1 in 28 Americans over the age of 40 and the prevalence increases sharply with age. However, experiencing vision loss with aging can be very different from aging with VI acquired earlier in life. People aging with VI may be at increased risk for diabetes due to environmental barriers in accessing health care, healthy food, and recreational resources that can facilitate positive health behaviors.ObjectiveThis study examined the relationship between neighborhood characteristics and incident type 2 diabetes mellitus (T2DM) among a cohort of 22,719 adults aging with VI.MethodsData are from Optum® Clinformatics® DataMart, a private administrative claims database (2008–2017). Individuals 18 years of age and older at the time of their initial VI diagnosis were eligible for analysis. VI was determined using vision impairment, low vision, and blindness codes (ICD-9-CM, ICD-10-CM). Covariates included age, sex, and comorbidities. Cox models estimated adjusted hazard ratios (HRs) for incident T2DM. Stratified models examined differences in those aging with (age 18–64) and aging into (age 65+) vision impairment.ResultsResidence in neighborhoods with greater intersection density (HR = 1.26) and high-speed roads (HR = 1.22) were associated with increased risk of T2DM among older adults with VI. Living in neighborhoods with broadband internet access (HR = 0.67), optical stores (HR = 0.62), supermarkets (HR = 0.78), and gyms/fitness centers (HR = 0.63) was associated with reduced risk of T2DM for both younger and older adults with VI.ConclusionsFindings emphasize the importance of neighborhood context for mitigating the adverse consequences of vision loss for health.     

糖尿病家族史和三高聚集与糖尿病患病的关系

目的 了解糖尿病家族史和三高聚集与糖尿病患病的关系,为制定适宜的糖尿病防治策略提供参考依据。方法 2019年10月至2020年4月采用多阶段随机抽样的方法,在江苏省南通市海门区随机抽取8981名18周岁以上常住居民,进行问卷调查和体格检查,采用t检验、x2检验、多因素非条件logistic回归研究糖尿病家族史和三高聚集对糖尿病患病的影响。结果 江苏省南通市海门区18周岁以上常住居民最终纳入8350名,糖尿病患病率11.2%,标化患病率5.4%。在调整了性别、年龄、文化程度、职业、总静态时间等混杂因素后,多因素非条件logistic回归分析结果显示,有糖尿病家族史者糖尿病患病风险是无家族史者的3.43倍（OR=3.43,95%CI=2.86～4.11）,超重肥胖者糖尿病患病风险是非超重肥胖者的1.60倍（OR=1.60,95%CI=1.39～1.83）,高三酰甘油血症者糖尿病患病风险是非患者的4.99倍（OR=4.99,95%CI=4.17～5.98）,高血压患者糖尿病患病风险是非患者的3.14倍（OR=3.14,95%CI=2.73～3.62）。当家族史合并1高时,以家族史合并高三酰甘油血症人群的糖尿病患病风险最高（OR=4.60,95%CI=4.01～5.29）,当家族史合并2高时,以家族史合并高三酰甘油血症、超重肥胖人群的糖尿病患病风险最高（OR=4.67,95%CI=4.08～5.37）,当家族史合并3高时,糖尿病患病风险达到最高（OR=5.72,95%CI=5.14～6.42）。结论 家族史合并危险因素聚集越多,糖尿病患病风险越高,应及时做好干预工作。     

125个家族高发性2型糖尿病的危险因素研究

目的 研究家族高发性2型糖尿病家系人群中可能的遗传和环境危险因素。方法 对1999～2001年门诊及住院的125个家庭高发性2型糖尿病先证者的家庭成员调查家族信息和环境危险因素,比较2型糖尿病患者、糖耐量减低(IGT)患者与非患者在环境危险因素的差异。采用Falconer法估算遗传度,用Penrose法进行多基因分析研究其遗传危险性。结果 三组人群甘油三酯、体重指数、腰臀比值、高血压史及体力活动史的构成比差异有极显著性(P<0.01),而其他血脂项目及冠心病史差异未见显著性。125个大家系的2型糖尿病遗传度为83.42％±5.84％,提示在这些家系中可能有显性主基因存在。多基因分析研究表明在该人群中,2型糖尿病可能符合多基因遗传模式。结论 2型糖尿病为多基因疾病,环境危险因素和遗传因素及其交互作用可能影响其发病。     

天津市社区成年肥胖人群糖尿病患病率和危险因素分析

目的 研究天津市社区成年肥胖人群2型糖尿病(T2DM)患病率及其危险因素.方法 2006年在天津市采用分层整群随机抽样方法抽取全市3个城区和3个郊县≥18岁的成年人进行现况调查,从中选取体重指数(BMI)≥28 kg/m2的人群,共2888人作为研究对象.经过考试培训的调查员对抽样人群进行面对面问卷调查和空腹血糖测定,空腹血糖值≥6.1 mmol/L者再进行餐后2 h血糖测定.描述该人群的T2DM患病率及其人群分布特征,分析患T2DM的危险因素.结果 天津市社区成年肥胖人群T2DM患病率为11.74%,女性患病率(13.90%)高于男性(8.75%).肥胖人群按不同人群特征分组后,不同年龄、文化程度、职业、地区和BMI之间T2DM患病率差异有统计学意义.经单因素和多因素的logistic回归分析,年龄(OR=1.383,95%CI:1.254～1.525)、性别(OR=1.591,95%CI:1.230～2.059)是成年肥胖人群患糖尿病的危险因素,食用水果(OR=0.867,95%CI:0.774～0.971)是保护因素.结论 肥胖人群的T2DM患病率较高,T2DM在不同肥胖人群特征的分布和影响因素与全人群有所不同,可能与肥胖者本身存在的危险因素有关.     

2型糖尿病危险因素分析

目的探索2型糖尿病危险因素,为社区预防糖尿病提供依据。方法对天津市红桥区丁字沽街道所属4个社区40岁以上人群中64例2型糖尿病患者进行匹配(1∶2)病例对照研究,采用条件logistic回归分析方法。结果单因素分析的结果提示,2型糖尿病可能的12个危险因素中与糖尿病发生有明显联系的危险因素有6个,保护因素有1个,家族史、父母身体肥胖、脑力劳动、自身超重及不良生活方式等是2型糖尿病的主要危险因素,体育锻炼是保护因素。结论 2型糖尿病是遗传及环境因素引起的内分泌代谢综合征,是常见慢性病,只有通过健康教育与社会预防才能得到适当控制。     

Neighborhood socioeconomic deprivation,perceived neighborhood factors,and cortisol responses to induced stress among healthy adults

Associations between measures of neighborhood socioeconomic deprivation and health have been identified, yet work is needed to uncover explanatory mechanisms. One hypothesized pathway is through stress, yet the few studies that have evaluated associations between characteristics of deprived neighborhoods and biomarkers of stress are mixed. This study evaluated whether objectively measured neighborhood socioeconomic deprivation and individual perceived neighborhood characteristics (i.e. social control and fear of crime) impacted cortisol responses to an induced stressor among older healthy adults. Data from Heart Scan, a sub-study of the Whitehall II cohort, were used to generate multilevel piecewise growth-curve models of cortisol trajectories after a laboratory stressor accounting for neighborhood and demographic characteristics. Neighborhood socioeconomic deprivation was significantly associated with individual perceptions of social control and fear of crime in the neighborhood while an association with blunted cortisol reactivity was only evidence among women. Social control was significantly associated with greater cortisol reactivity and mediation between neighborhood socioeconomic deprivation and cortisol reactivity was suggested among women. These findings support a gender-dependent role of neighborhood in stress process models of health.     

Obesity and its associations with hypertension and type 2 diabetes among Chinese adults age 40 years and over

AimTo investigate the prevalence of obesity in a Chinese community according to the World Health Organization recommended criteria for Asians in 2000 based on body mass index (BMI) and waist circumference (WC), and to examine the associations between obesity and the risk of hypertension and type 2 diabetes among adults age 40 years and over in Shanghai, China.MethodsA population-based survey was conducted in Youyi Community in Shanghai. Five thousand seventy-one subjects (1917 men and 3154 women) were included in this study. Standard questionnaires were used to collect baseline data of participants. Body weight, height, WC, blood pressure, and glucose in the blood were measured.ResultsThe prevalence of general obesity was 44.6% (46.4% for men and 43.6% for women) according to BMI and 36.1% (25.5% for men and 42.6% for women) for central obesity according to WC. The prevalence of obesity I was higher in men (41.6%) than in women (36.2%; χ² = 14.8, P < 0.05), although the rate was higher in women than in men for obesity II (7.4% versus 4.8%, χ² = 13.6, P < 0.01) or central obesity (42.6% versus 25.5%, χ² = 152.1, P < 0.01). Odds ratios of hypertension and type 2 diabetes were significantly higher in the obesity group compared with either the group with BMI 18.5–<23.0 kg/m² or the group with WC < 90 cm for men or <80 cm for women.ConclusionsAccording to the criteria of obesity for Asians, the prevalence of obesity among Chinese adults age 40 years and over in Shanghai is high. Subjects with obesity have a significantly higher risk of hypertension and type 2 diabetes.     

2型糖尿病合并骨质疏松的相关危险因素分析

目的分析2型糖尿病合并骨质疏松的骨密度变化及其糖代谢相关生化指标分析。方法将86例2型糖尿病患者按照骨密度分为单纯2型糖尿病组和2型糖尿病合并骨质疏松组,比较两组空腹血糖（FBG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、病程等,并对以上指标与骨密度进行相关性分析。以93例健康体检者作为健康对照组。结果健康体检者骨质疏松发生率明显低于2型糖尿病患者[28．0％（26／93）比59．3％（51／86）],差异有统计学意义（P〈0．05）。2型糖尿病合并骨质疏松组（51例）HbA1c、FINS、骨密度、病程与单纯2型糖尿病组（35例）比较差异均有统计学意义[（8．57±2．59）％比（7．26±1．68）％、（13．21±4．73）μU／L比（17．54±5．91）μU/L、（0．764±0．130）g／cm2比（0．993±0．123）g／cm2、（11．4±6．4）年比（8．6±4．7）年,P〈0．05]。2型糖尿病患者的骨密度与病程、HbA1c、FINS呈负相关（r=-0．306,-0．185,-0．269;P〈0．05或〈0．01）,而与FBG无相关性（P〉0．05）。结论长期血糖控制不良、体内胰岛素水平低下、病程长是2型糖尿病患者易合并骨质疏松的影响因素。     

社区人群2型糖尿病的危害因素分析

目的　研究社区 2型糖尿病易患因素 ,指导该病防治工作。方法　分层随机选择 10 36名社区人群进行糖尿病筛查 ,其中发现 2型糖尿病患者 87例 ,然后用成组匹配的方法选择对照组 90例作病例对照研究 ,寻找糖尿病危险因素。结果　糖尿病已成为社区高发病种 (8.39% )。机关干部患病率最高 ,农民患病率最底。病例对照研究发现 ,2型糖尿病组与对照组在饮酒、喜食甜食、吸烟、DM家族史、高脂血症史、冠心病史、女性巨大儿生育史、过多摄入动物脂肪等方面差异有显著性(P <0 .0 5 ) ,另外 2型糖尿病与高血压、冠心病、眼病、糖尿病肾病相关 (P <0 .0 5 )。结论　饮酒、吸烟、高血压、高血脂、过多摄入动物脂肪 ,女性巨大儿生育史是 2型糖尿病危险因素     

Gestational exposure to neighborhood police-reported crime and early childhood blood pressure in Durham,NC

Gestational exposure to police-reported crime is associated with adverse birth outcomes, but no previous research has evaluated the effects of gestational crime exposure on early childhood health or attempted to disentangle the health effects of neighborhood crime from the effects of neighborhood policing. Using data from 672 Newborn Epigenetics Study participants, we evaluate the effects of gestational exposure to violent crime and racialized drug policing on early childhood blood pressure. We demonstrate that violence and drug policing are consistently associated with increased blood pressure among children born to Black participants but not White or Latinx participants.     

Associations between neighborhood perceptions and mental well-being among older adults

This study examined whether perceived neighborhood factors were associated with positive well-being in older adults using data from the English Longitudinal Study of Ageing. Neighborhood perceptions were assessed at baseline (2006/2007) and three measures of well-being – hedonic, eudaimonic and evaluative – were assessed at baseline and follow-up (2010/2011) for 6134 participants. In cross-sectional and longitudinal analyses, negative neighborhood perceptions were associated with poorer well-being on all three measures. These associations remained significant after adjusting for a range of sociodemographic and health status variables and depressive symptoms.     

蚌埠市社区绿地暴露与成年居民糖尿病患病率的关系: BMI的中介作用

目的  了解蚌埠市龙子湖区社区绿地暴露与糖尿病(diabetes mellitus, DM)患病率的相关性,并探讨BMI在社区绿地暴露与DM之间的中介效应。方法  2015年8月,采用分层随机抽样,调查蚌埠市龙子湖区成年居民3 354人。居民基本信息以问卷形式收集,社区绿地暴露用归一化植被指数(normalized difference vegetation index,NDVI)和土壤调整植被指数(soil adjusted vegetation index,SAVI)1 000 m缓冲区的值表示。用二分类Logistic回归分析探究社区绿地暴露与DM的相关性,并评估BMI的中介效应。结果  NDVI-1 000 m (χ²=36.39, P < 0.001)与SAVI-1 000 m(χ²=20.14, P < 0.001)不同组之间患病率均存在统计学差异。调整模型下,NDVI-1 000 m和SAVI-1 000 m Q3组患病率分别是Q1组的0.538倍(OR=0.538,95% CI: 0.388~0.745)和0.605倍(OR=0.605,95% CI: 0.440~0.833)。BMI在NDVI-1 000 m和SAVI-1 000 m与DM的关联分别存在6.42%(95% CI: 1.83%~16.00%)和7.43%(95% CI: 2.36%~19.00%)的中介效应。结论  社区绿地暴露越高,DM患病率越低。BMI在社区绿地暴露与DM之间有中介效应。     

老年2型糖尿病患者糖尿病视网膜病变相关因素分析

目的探讨老年2型糖尿病患者发生糖尿病视网膜病变的相关因素。方法选择我院收治的老年2型糖尿病患者180例,其中90例伴有视网膜病变为观察组,90例不伴有视网膜病变为对照组,分析两组患者的病程、空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压、舒张压、总胆固醇、血清脂蛋白α、载脂蛋白A1、载脂蛋白B等因素与糖尿病视网膜病变发生的相关性。结果两组患者病程、空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压、舒张压、总胆固醇、血清脂蛋白α、载脂蛋白A1、载脂蛋白B方面比较具统计学意义(P<0.05)。结论病程、空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压、舒张压、总胆固醇、血清脂蛋白α、载脂蛋白A1、载脂蛋白B等均是发生视网膜病变的主要相关因素,对于存在有高危因素的老年2型糖尿病患者应给予定期眼底检查。     

Residential self-selection,perceived built environment and type 2 diabetes incidence: A longitudinal analysis of 36,224 middle to older age adults

Much of the existing studies on the built environment and type 2 diabetes are cross-sectional and prone to residential self-selection bias. Using multilevel logistic regression analysis of 36,224 participants from a longitudinal study, we examined whether perceived built environment characteristics are associated with type 2 diabetes. We found that the odds of diabetes incidence varied geographically. Those who reported that there were no local amenities and reported day- and night-time crime rates made walking unsafe in the neighbourhood had higher odds of developing incident type 2 diabetes. These associations persisted after accounting for some predictors of residential self-selection. More longitudinal studies are needed to corroborate the findings. Changing the features of the residential built environment may be an important point of intervention for type 2 diabetes prevention.     

2型糖尿病危险因素的病例对照研究

目的探讨2型糖尿病的危险因素,为制定干预措施提供依据。方法将203例确诊的2型糖尿病患者作为研究对象,1∶1配对进行病例对照研究。通过条件Logistic回归分析筛选主要危险因素。结果糖尿病家族史（OR=3.540）、高血脂（OR=3.420）、工作紧张度（OR=3.174）、腰臀比（OR=2.173）、高血压史（OR=2.033）、嗜甜食（OR=1.751）是2型糖尿病的主要危险因素。结论 2型糖尿病与遗传等因素有关,针对高危人群应采取合理膳食、保持良好心理状态、控制体重和血压等综合干预措施。     

糖尿病患者结核病患病情况及危险因素分析

目的分析糖尿病患者中结核病的患病情况及危险因素,为结核病的早期发现提供参考依据。方法采用分层随机整群抽样方法对在山东省宁阳县和沂水县24个乡镇518个村筛查出的4 085例糖尿病患者进行结核病的诊断与问卷调查,并采用多因素logistic回归模型对危险因素进行分析。结果4 085例糖尿病患者中发现结核病患者14例,其中13例为新发病例,1例为复治涂阳病例,糖尿病患者结核病患病率为342.72/10万;不同特征糖尿病患者结核病患病情况比较,不同性别、体质指数、焦虑症状糖尿病患者结核病患病情况差异均有统计学意义(P<0.05);多因素logistic回归分析结果表明,男性(OR=5.057,95%CI=1.562~16.377)、体质指数<18.5 kg/m²(OR=16.189,95%CI=2.588~101.260)、有焦虑症状(OR=5.214,95%CI=1.772~15.339)是糖尿病患者患结核病的危险因素;与糖尿病患者比较,糖尿病合并结核病患者在过去24 h更易出现咳嗽、发热、高热、乏力的症状(均P<0.05),在过去1个月更易出现咳嗽、咯痰、高热的症状(均P<0.05)。结论糖尿病患者结核病患病率较高,男性、体重较轻、有焦虑症状的糖尿病患者更易患结核病。     

老年2型糖尿病泌尿系感染特点及危险因素分析

目的 探讨老年2型糖尿病泌尿系感染致病菌及其耐药性特点,并分析导致泌尿系统感染发生的危险因素.方法 在288例老年2型糖尿病患者中选取发生泌尿系统感染的74例患者作为研究对象,收集其尿液标本进行病原菌培养及药敏试验;分别采用单因素分析及多因素logistic回归分析对性别、年龄、血糖、糖化血红蛋白、并发症、侵入性操作等因素进行分析以确定危险因素.结果 74例发生泌尿系统感染患者中共分离出病原菌102株,其中革兰阴性菌66株,占64.71％,革兰阳性菌36株,占35.29％,排名前5位的病原菌分别为大肠埃希菌、表皮葡萄球菌、肠球菌属、变形菌属及肺炎克雷伯菌,分别占40.20％、20.59％、12.75％、9.80％、5.88％;革兰阴性菌对亚胺培南及美罗培南敏感性较高,敏感率＞97.0％,革兰阳性菌对替考拉宁敏感性较高,未发现万古霉素耐药菌;年龄≥70岁、女性、糖尿病病程≥10年、侵入性操作、空腹血糖≥13.9 mmol/L、糖化血红蛋白≥8％、住院时间≥1个月以及具有慢性并发症为老年2型糖尿病患者发生泌尿系统感染的危险因素.结论 治疗时可对老年2型糖尿病泌尿系统感染的危险因素进行干预,感染后应进行尿细菌培养并选择合适的抗菌药物.     

Depression,neighborhood deprivation and risk of type 2 diabetes

Neighborhood characteristics have been associated with both depression and diabetes, but to date little attention has been paid to whether the association between depression and diabetes varies across different types of neighborhoods. This prospective study examined the relationship between depression, neighborhood deprivation, and risk of type 2 diabetes among 336,340 adults from a national-representative sample of primary care centers in Sweden (2001–2007). Multi-level logistic regression models were used to assess associations between depression and risk of type 2 diabetes across affluent and deprived neighborhoods. After accounting for demographic, individual-level socioeconomic, and health characteristics, depression was significantly associated with risk of diabetes (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.06–1.14), as was neighborhood deprivation (OR for high vs. low deprivation: 1.66, 95% CI: 1.22–1.34). The interaction term between depression and neighborhood deprivation was non-significant, indicating that the relationship between depression and diabetes risk is similar across levels of neighborhood socioeconomic deprivation.