美国患者结局研究促进学习（PORTAL）多中心队列中按 BMI 划分的糖尿病和糖尿病前期的种族/民族差异：成年人
Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S.
机构信息
Division of Research, Kaiser Permanente Northern California, Oakland, CA
University of California, San Francisco, San Francisco, CA.
出版信息
Diabetes Care. 2019 Dec;42(12):2211-2219. doi: 10.2337/dc19-0532. Epub 2019 Sep 19.
OBJECTIVE
To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category.
RESEARCH DESIGN AND METHODS
In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012-2013 were included. Diabetes and prediabetes were ascertained by diagnosis and laboratory results; antihyperglycemic medications were also included for diabetes ascertainment.
RESULTS
The age-standardized diabetes and prediabetes prevalence estimates were 15.9% and 33.4%, respectively. Diabetes but not prediabetes prevalence increased across BMI categories among all racial/ethnic groups ( for trend < 0.001). Racial/ethnic minorities reached a given diabetes prevalence at lower BMIs than whites; Hawaiians/Pacific Islanders and Asians had a diabetes prevalence of 24.6% (95% CI 24.1-25.2%) in overweight and 26.5% (26.3-26.8%) in obese class 1, whereas whites had a prevalence of 23.7% (23.5-23.8%) in obese class 2. The age-standardized prediabetes prevalence estimates in overweight among Hispanics (35.6% [35.4-35.7%]), Asians (38.1% [38.0-38.3%]), and Hawaiians/Pacific Islanders (37.5% [36.9-38.2%]) were similar to those in obese class 4 among whites (35.3% [34.5-36.0%]), blacks (36.8% [35.5-38.2%]), and American Indians/Alaskan Natives (34.2% [29.6-38.8%]). In adjusted models, the strength of association between BMI and diabetes was highest among whites (relative risk comparing obese class 4 with normal weight 7.64 [95% CI 7.50-7.79]) and lowest among blacks (3.16 [3.05-3.27]). The association between BMI and prediabetes was less pronounced.
CONCLUSIONS
Racial/ethnic minorities had a higher burden of diabetes and prediabetes at lower BMIs than whites, suggesting the role of factors other than obesity in racial/ethnic disparities in diabetes and prediabetes risk and highlighting the need for tailored screening and prevention strategies.
目的
按 BMI 类别检查糖尿病和糖尿病前期的流行率在种族/民族差异中的情况。
研究设计和方法
在三个美国综合医疗保健系统的联盟中，纳入了 2012-2013 年间年龄≥20 岁的 4906238 个人。通过诊断和实验室结果确定糖尿病和糖尿病前期；也将降血糖药物包括在内以确定糖尿病。
结果
年龄标准化的糖尿病和糖尿病前期的患病率估计分别为 15.9%和 33.4%。在所有种族/民族群体中，随着 BMI 类别增加，糖尿病（趋势<0.001）但不是糖尿病前期的患病率增加。与白人相比，少数民族在较低的 BMI 时就达到了一定的糖尿病患病率；夏威夷/太平洋岛民和亚洲人超重时的糖尿病患病率为 24.6%（95%CI 24.1-25.2%），肥胖 1 级时为 26.5%（26.3-26.8%），而白人肥胖 2 级时的患病率为 23.7%（23.5-23.8%）。超重的西班牙裔（35.6%[35.4-35.7%]）、亚洲人（38.1%[38.0-38.3%]）和夏威夷/太平洋岛民（37.5%[36.9-38.2%]）的年龄标准化糖尿病前期患病率与白人肥胖 4 级（35.3%[34.5-36.0%]）、黑人（36.8%[35.5-38.2%]）和美洲印第安人/阿拉斯加原住民（34.2%[29.6-38.8%]）相似。在调整后的模型中，BMI 与糖尿病之间的关联强度在白人中最高（肥胖 4 级与正常体重相比的相对风险为 7.64[95%CI 7.50-7.79]），在黑人中最低（3.16[3.05-3.27]）。BMI 与糖尿病前期之间的关联则不那么明显。
结论
与白人相比，少数民族在较低的 BMI 时就有更高的糖尿病和糖尿病前期负担，这表明在糖尿病和糖尿病前期风险的种族/民族差异中，肥胖以外的因素起作用，并强调需要制定有针对性的筛查和预防策略。
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