Fleischer Nancy L, Henderson Andrea K, Wu Yun-Hsuan, Liese Angela D, McLain Alexander C
Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina;.
Department of Sociology, University of South Carolina, Columbia, South Carolina.
Am J Prev Med. 2016 Dec;51(6):947-957. doi: 10.1016/j.amepre.2016.06.019. Epub 2016 Aug 21.
Diabetes mellitus incidence has more than doubled in the U.S. over the past 2 decades. Not all sectors of the population have experienced the increase proportionally. The goal of this study was to determine if disparities in diabetes by education and race/ethnicity have increased over time, and if there are differences by gender and birth cohort.
Repeated cross-sectional data were used from the 1973-2012 National Health Interview Survey of adults aged 25-84 years. Logistic regression models were run and predicted probabilities were calculated to determine if disparities in self-reported diabetes by education and race/ethnicity changed over time, by gender and birth cohort (birth before 1946, 1946-1970, 1971 or after). Analyses were conducted in 2014-2015.
Relationships between education or race/ethnicity and diabetes were modified by time for people born before 1971, with stronger effect modification for women than men. Inequalities in diabetes prevalence grew over time, although the magnitude of disparities was smaller for the 1946-1970 cohort. For example, in 2005-2012, the gap in diabetes prevalence for women with the highest and lowest levels of education was 12.7% for pre-1946 versus 7.9% for 1946-1970. Similar trends were seen for differences between non-Hispanic whites and non-Hispanic blacks or Hispanics. Results were inconclusive for the youngest cohort.
Diabetes disparities are evident. Smaller differences in later cohorts may indicate that large structural changes in society (e.g., Civil Rights movement, increased educational and economic opportunities) have benefited later generations.
在过去20年里，美国糖尿病发病率增加了一倍多。并非所有人群都按比例出现了这种增长。本研究的目的是确定糖尿病在教育程度和种族/族裔方面的差异是否随时间增加，以及是否存在性别和出生队列差异。
使用1973 - 2012年对25 - 84岁成年人进行的全国健康访谈调查的重复横断面数据。运行逻辑回归模型并计算预测概率，以确定自我报告的糖尿病在教育程度和种族/族裔方面的差异是否随时间、性别和出生队列（1946年以前出生、1946 - 1970年、1971年及以后出生）而变化。分析在2014 - 2015年进行。
1971年以前出生的人群中，教育程度或种族/族裔与糖尿病之间的关系随时间而变化，女性的效应修正比男性更强。糖尿病患病率的不平等随时间增加，尽管1946 - 1970年队列的差异幅度较小。例如，在2005 - 2012年，教育程度最高和最低的女性糖尿病患病率差距，1946年以前出生的人群为12.7%，而1946 - 1970年出生的人群为7.9%。非西班牙裔白人与非西班牙裔黑人或西班牙裔之间的差异也有类似趋势。最年轻队列的结果尚无定论。
糖尿病差异明显。较年轻队列中差异较小可能表明社会的重大结构变化（如民权运动、教育和经济机会增加）使后代受益。
