Okwechime Ifechukwude Obiamaka, Roberson Shamarial, Odoi Agricola
Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, United States of America.
Florida Department of Health, Bureau of Chronic Disease Prevention, Tallahassee, Florida, United States of America.
PLoS One. 2015 Dec 29;10(12):e0145781. doi: 10.1371/journal.pone.0145781. eCollection 2015.
Individuals with pre-diabetes and diabetes have increased risks of developing macro-vascular complications including heart disease and stroke; which are the leading causes of death globally. The objective of this study was to estimate the prevalence of pre-diabetes and diabetes, and to investigate their predictors among adults ≥18 years in Florida.
Data covering the time period January-December 2013, were obtained from Florida's Behavioral Risk Factor Surveillance System (BRFSS). Survey design of the study was declared using SVYSET statement of STATA 13.1. Descriptive analyses were performed to estimate the prevalence of pre-diabetes and diabetes. Predictors of pre-diabetes and diabetes were investigated using multinomial logistic regression model. Model goodness-of-fit was evaluated using both the multinomial goodness-of-fit test proposed by Fagerland, Hosmer, and Bofin, as well as, the Hosmer-Lemeshow's goodness of fit test.
There were approximately 2,983 (7.3%) and 5,189 (12.1%) adults in Florida diagnosed with pre-diabetes and diabetes, respectively. Over half of the study respondents were white, married and over the age of 45 years while 36.4% reported being physically inactive, overweight (36.4%) or obese (26.4%), hypertensive (34.6%), hypercholesteremic (40.3%), and 26% were arthritic. Based on the final multivariable multinomial model, only being overweight (Relative Risk Ratio [RRR] = 1.85, 95% Confidence Interval [95% CI] = 1.41, 2.42), obese (RRR = 3.41, 95% CI = 2.61, 4.45), hypertensive (RRR = 1.69, 95% CI = 1.33, 2.15), hypercholesterolemic (RRR = 1.94, 95% CI = 1.55, 2.43), and arthritic (RRR = 1.24, 95% CI = 1.00, 1.55) had significant associations with pre-diabetes. However, more predictors had significant associations with diabetes and the strengths of associations tended to be higher than for the association with pre-diabetes. For instance, the relative risk ratios for the association between diabetes and being overweight (RRR = 2.00, 95% CI = 1.55, 2.57), or obese (RRR = 4.04, 95% CI = 3.22, 5.07), hypertensive (RRR = 2.66, 95% CI = 2.08, 3.41), hypercholesterolemic (RRR = 1.98, 95% CI = 1.61, 2.45) and arthritic (RRR = 1.28, 95% CI = 1.04, 1.58) were all further away from the null than their associations with pre-diabetes. Moreover, a number of variables such as age, income level, sex, and level of physical activity had significant association with diabetes but not pre-diabetes. The risk of diabetes increased with increasing age, lower income, in males, and with physical inactivity. Insufficient physical activity had no significant association with the risk of diabetes or pre-diabetes.
There is evidence of differences in the strength of association of the predictors across levels of diabetes status (pre-diabetes and diabetes) among adults ≥18 years in Florida. It is important to monitor populations at high risk for pre-diabetes and diabetes, so as to help guide health programming decisions and resource allocations to control the condition.
糖尿病前期和糖尿病患者发生大血管并发症（包括心脏病和中风）的风险增加；这些是全球主要的死亡原因。本研究的目的是估计佛罗里达州18岁及以上成年人中糖尿病前期和糖尿病的患病率，并调查其预测因素。
获取了2013年1月至12月期间佛罗里达州行为风险因素监测系统（BRFSS）的数据。使用STATA 13.1的SVYSET语句声明了该研究的调查设计。进行描述性分析以估计糖尿病前期和糖尿病的患病率。使用多项逻辑回归模型研究糖尿病前期和糖尿病的预测因素。使用Fagerland、Hosmer和Bofin提出的多项拟合优度检验以及Hosmer-Lemeshow拟合优度检验评估模型的拟合优度。
佛罗里达州分别约有2983名（7.3%）和5189名（12.1%）成年人被诊断为糖尿病前期和糖尿病。超过一半的研究受访者为白人、已婚且年龄超过45岁，而36.4%的人报告身体不活动、超重（36.4%）或肥胖（26.4%）、高血压（34.6%）、高胆固醇血症（40.3%），26%患有关节炎。基于最终的多变量多项模型，只有超重（相对风险比[RRR]=1.85，95%置信区间[95%CI]=1.41，2.42）、肥胖（RRR=3.41，95%CI=2.61，4.45）、高血压（RRR=1.69，95%CI=1.33，2.15）、高胆固醇血症（RRR=1.94，95%CI=1.55，2.43）和患有关节炎（RRR=1.24，95%CI=1.00，1.55）与糖尿病前期有显著关联。然而，更多的预测因素与糖尿病有显著关联，且关联强度往往高于与糖尿病前期的关联。例如，糖尿病与超重（RRR=2.00，95%CI=1.55，2.57）或肥胖（RRR=4.04，95%CI=3.22，5.07）、高血压（RRR=2.66，95%CI=2.08，3.41）、高胆固醇血症（RRR=1.98，95%CI=1.61，2.45）和患有关节炎（RRR=1.28，95%CI=1.04，1.58）之间关联的相对风险比均比其与糖尿病前期的关联更远离无效值。此外，一些变量如年龄、收入水平、性别和身体活动水平与糖尿病有显著关联，但与糖尿病前期无显著关联。糖尿病风险随年龄增加、收入降低、男性以及身体不活动而增加。身体活动不足与糖尿病或糖尿病前期风险无显著关联。
有证据表明，佛罗里达州18岁及以上成年人中，糖尿病状态（糖尿病前期和糖尿病）各水平的预测因素关联强度存在差异。监测糖尿病前期和糖尿病的高危人群很重要，以便帮助指导健康规划决策和资源分配以控制病情。
