社会经济地位低下与糖尿病患者低血糖风险增加相关：北加利福尼亚糖尿病研究（DISTANCE）。
Low socioeconomic status is associated with increased risk for hypoglycemia in diabetes patients: the Diabetes Study of Northern California (DISTANCE).
作者信息
Berkowitz Seth A, Karter Andrew J, Lyles Courtney R, Liu Jennifer Y, Schillinger Dean, Adler Nancy E, Moffet Howard H, Sarkar Urmimala
出版信息
J Health Care Poor Underserved. 2014 May;25(2):478-90. doi: 10.1353/hpu.2014.0106.
BACKGROUND
Social risk factors for hypoglycemia are not well understood.
METHODS
Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors.
RESULTS
14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs. high-income (16% vs. 8.8) and low-education vs. high-education (11.9% vs. 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19-1.91), $15,000-$24,999 (OR 1.57 95%CI 1.27-1.94), and high school or less education (OR 1.42, 95% CI 1.24-1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19-1.74).
CONCLUSIONS
Low income and educational attainment are important risk factors for hypoglycemia.
背景
低血糖的社会风险因素尚未得到充分了解。
方法
对DISTANCE研究进行横断面分析，该研究于2005 - 2006年在凯撒医疗集团北加利福尼亚糖尿病登记处进行，是一个多语言、按种族分层的成年人随机样本（应答率62%）。暴露因素为收入和教育程度；结局为患者报告的严重低血糖情况。为检验两者之间的关联，我们使用多变量逻辑回归来调整人口统计学和临床因素。
结果
纳入了14357名患者。严重低血糖的报告很常见（11%），低收入组（16%）高于高收入组（8.8%），低教育程度组（11.9%）高于高教育程度组（8.9%）。在多变量分析中，收入低于15000美元（比值比1.51，95%置信区间1.19 - 1.91）、15000 - 24999美元（比值比1.57，95%置信区间1.27 - 1.94）以及高中及以下教育程度（比值比1.42，95%置信区间1.24 - 1.63）与低血糖增加相关，与使用胰岛素的情况相似（比值比1.44，95%置信区间1.19 - 1.74）。
结论
低收入和低教育程度是低血糖的重要风险因素。
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