Piccolo Rebecca S, Subramanian S V, Pearce Neil, Florez Jose C, McKinlay John B
London School of Hygiene and Tropical Medicine, London, U.K.
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
Diabetes Care. 2016 Jul;39(7):1208-17. doi: 10.2337/dc15-2255.
Racial/ethnic minorities in the U.S. have a higher prevalence of type 2 diabetes mellitus (T2DM) than white adults. While many independent risk factors for T2DM have been identified, these determinants are often viewed in isolation without considering the joint contributions of competing risk factors. The objective of this study was to assess the relative contributions of six domains of influence to racial/ethnic disparities in T2DM.
Cross-sectional analyses were conducted using the Boston Area Community Health III Survey (2010-2012), the third wave of a population-based sample of men and women from three racial/ethnic groups (black, Hispanic, white) living in Boston, Massachusetts (N = 2,764). Prevalent diabetes was defined by self-report of T2DM, fasting glucose >125 mg/dL, or HbA1c ≥6.5%. Structural equation models were constructed to evaluate the direct effects of each conceptual domain of influence on T2DM prevalence, as well as their indirect effects on the race/ethnicity-T2DM relationship. All direct and indirect pathways were included.
The final model indicated that 38.9% and 21.8% of the total effect of black race and Hispanic ethnicity, respectively, on T2DM prevalence was mediated by the socioeconomic, environmental, psychosocial, and lifestyle/behavioral risk scores. The largest mediating influence was the socioeconomic risk score, which explained 21.8% and 26.2% of the total effect of black race and Hispanic ethnicity, respectively.
Our study found that socioeconomic factors had the greatest impact on explaining the excess prevalence of T2DM among racial/ethnic minorities.
美国的种族/族裔少数群体患2型糖尿病（T2DM）的患病率高于白人成年人。虽然已经确定了许多T2DM的独立危险因素，但这些决定因素往往被孤立看待，而没有考虑竞争风险因素的共同作用。本研究的目的是评估六个影响领域对T2DM种族/族裔差异的相对贡献。
使用波士顿地区社区健康III调查（2010 - 2012年）进行横断面分析，这是对居住在马萨诸塞州波士顿的三个种族/族裔群体（黑人、西班牙裔、白人）的男性和女性进行的基于人群样本的第三次调查（N = 2,764）。糖尿病患病率通过T2DM的自我报告、空腹血糖>125 mg/dL或糖化血红蛋白（HbA1c）≥6.5%来定义。构建结构方程模型以评估每个概念影响领域对T2DM患病率的直接影响，以及它们对种族/族裔与T2DM关系的间接影响。纳入了所有直接和间接途径。
最终模型表明，黑人种族和西班牙裔族裔对T2DM患病率的总影响中，分别有38.9%和21.8%由社会经济、环境、心理社会和生活方式/行为风险评分介导。最大的中介影响是社会经济风险评分，它分别解释了黑人种族和西班牙裔族裔总影响的21.8%和26.2%。
我们的研究发现，社会经济因素对解释种族/族裔少数群体中T2DM的过高患病率影响最大。
