Doctor of Medicine Programme, Duke-NUS Medical School, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
BMJ Open Diabetes Res Care. 2021 Jul;9(1). doi: 10.1136/bmjdrc-2020-002064.
The burden of type 2 diabetes mellitus (T2DM) and related vascular complications is particularly high in Asians and ethnic minorities living in the West. However, the association of T2DM with socioeconomic status (SES) and ethnicity has not been widely studied in populations living in Asia. Therefore, we investigated these associations among the multiethnic population with uncontrolled hypertension in Singapore.
In a cross-sectional study using baseline data of a 2-year randomized trial in Singapore, we obtained demographic, SES, lifestyle and clinical factors from 915 patients aged ≥40 years with uncontrolled hypertension. T2DM was defined as having either: (i) self-reported 'physician-diagnosed diabetes confirmed through medical records' or taking antidiabetes medications, (ii) fasting blood glucose levels ≥7.0 mmol/dL or (iii) hemoglobin A1c ≥6.5%. The SES proxies included education, employment status, housing ownership and housing type, and the ethnicities were Chinese, Malays and Indians. Logistic regression analyses were used to evaluate the association of T2DM with SES and ethnicity.
Higher proportion of T2DM was observed in Malays (40.0%) and Indians (56.0%) than Chinese (26.8%) (p<0.001), and in patients with lower SES (ranging from 25.7% to 66.2% using different proxies) than those with higher SES (19.4% to 32.0%). In a multivariate model comprising age, gender, ethnicity and SES, Malay ethnicity (OR 1.59; 95% CI 1.04 to 2.44, p=0.031) or Indian ethnicity (OR 3.65; 95% CI 2.25 to 5.91, p<0.001) versus Chinese and housing type (residing in one to three rooms (OR 2.00; 95% CI 1.16 to 3.43, p=0.012) or four to five rooms public housing (OR 1.86; 95% CI 1.13 to 3.04, p=0.013) vs private housing) were associated with higher T2DM odds. The associations of Indians and one to three rooms public housing with T2DM met the significance after accounting for multiple testing (p≤0.0125).
Our study suggests that housing type and ethnic variation are independently associated with higher T2DM risk in patients with uncontrolled hypertension in Singapore. Further studies are needed to validate our results.
NCT02972619.
2 型糖尿病（T2DM）及其相关血管并发症的负担在西方的亚洲人和少数民族中尤其高。然而，在亚洲人群中，T2DM 与社会经济地位（SES）和种族的关联尚未得到广泛研究。因此，我们调查了新加坡多民族未控制高血压人群中的这些关联。
在新加坡一项为期 2 年的随机试验的基线数据的横断面研究中，我们从 915 名年龄≥40 岁的未控制高血压患者中获得了人口统计学、SES、生活方式和临床因素。T2DM 的定义为：（i）自我报告的“经医生诊断的糖尿病，通过病历证实”或服用抗糖尿病药物，（ii）空腹血糖水平≥7.0mmol/dL 或（iii）糖化血红蛋白≥6.5%。SES 代表包括教育、就业状况、住房所有权和住房类型，种族包括华人、马来人和印度人。使用逻辑回归分析评估 T2DM 与 SES 和种族的关联。
与中国人（26.8%）相比，马来人（40.0%）和印度人（56.0%）中 T2DM 的比例更高（p<0.001），与 SES 较高的患者（使用不同的代表，范围从 25.7%到 66.2%）相比，SES 较低的患者（19.4%到 32.0%）中 T2DM 的比例更高。在一个包含年龄、性别、种族和 SES 的多变量模型中，马来族（OR 1.59；95%CI 1.04 至 2.44，p=0.031）或印度族（OR 3.65；95%CI 2.25 至 5.91，p<0.001）与中国人相比，以及与住房类型（居住在一到三间房（OR 2.00；95%CI 1.16 至 3.43，p=0.012）或四到五间公屋（OR 1.86；95%CI 1.13 至 3.04，p=0.013）与私人住房）与更高的 T2DM 几率相关。在考虑到多次检验（p≤0.0125）后，印度人和一到三间公屋与 T2DM 的关联具有统计学意义。
我们的研究表明，住房类型和族裔差异与新加坡未控制高血压患者的更高 T2DM 风险独立相关。需要进一步的研究来验证我们的结果。
NCT02972619。
