College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
Department of Sociology and Department of Epidemiology & Biostatistics, The George Washington University, Washington, DC 20052, USA.
J Diabetes Complications. 2021 Apr;35(4):107851. doi: 10.1016/j.jdiacomp.2021.107851. Epub 2021 Jan 9.
Aim Disparities exist in cardiovascular diseases (CVD) and diabetes in the United States (U.S.) with Central Appalachia having disproportionate burden. This study examined prevalence and correlates of CVD risk-factors among patients with diabetes/subclinical atherosclerosis in Central Appalachia.
During 2012-2016, 3000 patients from Central Appalachia were screened for subclinical atherosclerosis, using coronary artery calcium (CAC) scores; 419 participants had diabetes. Patients were categorized into four groups, with emphasis on those having subclinical atherosclerosis, CAC score ≥ 1. Descriptive statistics and multilevel multinomial logistic regression were conducted to identify CVD risk and spatial factors associated with co-existence of diabetes and subclinical atherosclerosis.
Among participants, prevalence of CVD risk-factors ranged from 11.7% for current smokers to 69.2% for those with CVD family history. Average BMI was 29.8. Compared to patients with diabetes only, age [RR = 1.07; p ≤ 0.0001], being male [RR = 5.33; p ≤ 0.0001], having hypertension [RR = 2.37; p ≤ 0.05] and being a former smoker were associated with increased likelihood of having diabetes/subclinical atherosclerosis. At the zip-code level, unemployment rate [RR = 1.37; p ≤ 0.05] was significantly associated with having diabetes/subclinical atherosclerosis.
Consistent with clinical guidelines, study results suggest the need to integrate CAC screening into primary care diabetes programs while addressing spatial issues that predispose patients to have diabetes/subclinical atherosclerosis.
美国（U.S.）在心血管疾病（CVD）和糖尿病方面存在着明显的差异，而中心阿巴拉契亚地区的负担则不成比例。本研究旨在探讨中心阿巴拉契亚地区患有糖尿病/亚临床动脉粥样硬化患者的 CVD 风险因素的患病率和相关因素。
在 2012 年至 2016 年期间，对来自中心阿巴拉契亚地区的 3000 名患者进行了亚临床动脉粥样硬化筛查，使用冠状动脉钙（CAC）评分；419 名参与者患有糖尿病。患者被分为四组，重点关注那些患有亚临床动脉粥样硬化、CAC 评分≥1 的患者。采用描述性统计和多级多项逻辑回归分析方法，确定与糖尿病和亚临床动脉粥样硬化共存相关的 CVD 风险因素和空间因素。
在参与者中，CVD 风险因素的患病率从当前吸烟者的 11.7%到有 CVD 家族史者的 69.2%不等。平均 BMI 为 29.8。与仅患有糖尿病的患者相比，年龄[RR=1.07；p≤0.0001]、男性[RR=5.33；p≤0.0001]、高血压[RR=2.37；p≤0.05]和曾经吸烟者患糖尿病/亚临床动脉粥样硬化的可能性更大。在邮政编码层面，失业率[RR=1.37；p≤0.05]与患糖尿病/亚临床动脉粥样硬化显著相关。
与临床指南一致，研究结果表明，需要将 CAC 筛查纳入初级保健糖尿病计划，同时解决导致患者易患糖尿病/亚临床动脉粥样硬化的空间问题。
