Fazli Ghazal S, Moineddin Rahim, Bierman Arlene S, Booth Gillian L
MAP- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Diabetes Res Care. 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-000907.
The aim of this study was to compare absolute and relative rates of conversion from prediabetes to diabetes among non-European immigrants to Europeans and Canadian-born residents, overall, and by age and level of glycemia.
We conducted a retrospective cohort population-based study using administrative health databases from Ontario, Canada, to identify immigrants (n=23 465) and Canadian born (n=1 11 085) aged ≥20 years with prediabetes based on laboratory tests conducted between 2002 and 2011. Individuals were followed until 31 December 2013 for the development of diabetes using a validated algorithm. Immigration data was used to assign ethnicity based on country of origin, mother tongue, and surname. Fine and Gray's survival models were used to compare diabetes incidence across ethnic groups overall and by age and glucose category.
Over a median follow-up of 5.2 years, 8186 immigrants and 39 722 Canadian-born residents developed diabetes (7.1 vs 6.1 per 100 person-years, respectively). High-risk immigrant populations such as South Asians (HR: 1.72, 95% CI 1.55 to 1.99) and Southeast Asians (HR: 1.65, 95% CI 1.46 to 1.86) had highest risk of converting to diabetes compared with Western Europeans (referent). Among immigrants aged 20-34 years, the adjusted cumulative incidence ranged from 18.4% among Eastern Europeans to 52.3% among Southeast Asians. Conversion rates increased with age in all groups but were consistently high among South Asians, Southeast Asians and Sub-Saharan African/Caribbeans after the age of 35 years. On average, South Asians converted to diabetes 3.1-4.6 years earlier than Western Europeans and at an equivalent rate of conversion to Western Europeans who had a 0.5 mmol/L higher baseline fasting glucose value.
High-risk ethnic groups converted to diabetes more rapidly, at younger ages, and at lower fasting glucose values than European populations, leading to a shorter window for diabetes prevention.
本研究旨在比较非欧洲移民与欧洲及加拿大出生居民中，总体上以及按年龄和血糖水平划分的糖尿病前期向糖尿病转化的绝对和相对发生率。
我们利用加拿大安大略省的行政健康数据库开展了一项基于队列人群的回顾性研究，以识别2002年至2011年间接受实验室检测且年龄≥20岁的糖尿病前期移民（n = 23465）和加拿大出生居民（n = 111085）。使用经过验证的算法对个体进行随访，直至2013年12月31日，观察糖尿病的发生情况。根据原籍国、母语和姓氏，利用移民数据确定种族。使用Fine和Gray生存模型比较不同种族群体总体上以及按年龄和血糖类别划分的糖尿病发病率。
在中位随访5.2年期间，8186名移民和39722名加拿大出生居民患糖尿病（分别为每100人年7.1例和6.1例）。与西欧人（参照组）相比，南亚人（风险比：1.72，95%置信区间1.55至1.99）和东南亚人（风险比：1.65，95%置信区间1.46至1.86）等高风险移民群体患糖尿病的风险最高。在20 - 34岁的移民中，调整后的累积发病率从东欧人的18.4%到东南亚人的52.3%不等。所有群体的转化率均随年龄增长而增加，但35岁以后，南亚人、东南亚人和撒哈拉以南非洲/加勒比人始终保持较高水平。平均而言，南亚人患糖尿病的时间比西欧人早3.1 - 4.6年，且转化率与基线空腹血糖值高0.5 mmol/L的西欧人相当。
与欧洲人群相比，高风险种族群体患糖尿病的转化速度更快、年龄更小且空腹血糖值更低，导致糖尿病预防的窗口期更短。
