黎巴嫩 2 型糖尿病患者的健康社会决定因素与临床结局的关系。
Relationship between social determinants of health and clinical outcomes in adults with type 2 diabetes in Lebanon.
机构信息
Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon.
出版信息
J Natl Med Assoc. 2022 Aug;114(4):392-405. doi: 10.1016/j.jnma.2022.03.002. Epub 2022 Apr 6.
BACKGROUND
A growing number of ethnic minority populations in the United States are from the Middle East and North Africa (MENA) region, specifically Lebanon. This region is witnessing one of the highest expected increases in diabetes prevalence. However, limited data exists on how social determinants of health impact clinical care for diabetes in this population. The aim of this study was to assess the social determinants of health and their impact on clinical outcomes in Lebanese adults with type 2 diabetes (T2DM).
METHODS
A convenience sample of Lebanese patients with T2DM was recruited from primary health care centers in Lebanon. Data on demographics and social determinants of health, including socioeconomic status, neighborhood and built environment, as well as psychosocial variables were collected. Clinical outcomes including Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP) were measured. Unadjusted and adjusted linear regression models were used to test for associations between the independent variables and each of the outcomes.
RESULTS
Out of the 300 adults with T2DM, 52% were men, 73% were married and 64% had an education level below high school. Results from multivariate analyses showed that food insecurity (β = 0.16, p = 0.01), owning an air conditioner (β = -0.64, p = 0.01), and commuting by walking (β = -0.93, p = 0.01) were independently associated with A1C. Predictors of DBP were male gender (β = 3.59, p = 0.03), age (β = -0.19, p = 0.005) and lack of confidence in filling medical forms (β = -4.89, p = 0.007), while male gender was the only predictor of SBP (β = 7.41, p = 0.008).
CONCLUSIONS
This is the first study to examine the relationship between social determinants of health and clinical outcomes for diabetes in the MENA region. Our findings suggest that living in an underprivileged neighborhood and built environment was significantly and independently associated with poor clinical outcomes among adults with T2DM in Lebanon. Findings from this study will inform care for immigrant populations with diabetes from the MENA region.
背景
越来越多的美国少数民族来自中东和北非（MENA）地区，特别是黎巴嫩。该地区预计糖尿病患病率将大幅上升。然而，关于健康的社会决定因素如何影响该人群的糖尿病临床护理，相关数据有限。本研究旨在评估健康的社会决定因素及其对黎巴嫩 2 型糖尿病（T2DM）成人临床结局的影响。
方法
从黎巴嫩初级保健中心招募了便利抽样的黎巴嫩 T2DM 患者。收集了人口统计学和健康的社会决定因素数据，包括社会经济地位、邻里和建筑环境以及心理社会变量。测量了临床结局，包括糖化血红蛋白（A1C）、收缩压（SBP）和舒张压（DBP）。使用未调整和调整后的线性回归模型来检验自变量与每个结局之间的关联。
结果
在 300 名 T2DM 成年人中，52%为男性，73%已婚，64%的人受教育程度低于高中。多变量分析结果表明，食物无保障（β=0.16，p=0.01）、拥有空调（β=-0.64，p=0.01）和步行通勤（β=-0.93，p=0.01）与 A1C 独立相关。DBP 的预测因子为男性（β=3.59，p=0.03）、年龄（β=-0.19，p=0.005）和缺乏填写医疗表格的信心（β=-4.89，p=0.007），而男性是 SBP 的唯一预测因子（β=7.41，p=0.008）。
结论
这是第一项研究 MENA 地区健康的社会决定因素与糖尿病临床结局之间关系的研究。我们的研究结果表明，居住在贫困社区和建筑环境中与黎巴嫩 T2DM 成人的不良临床结局显著且独立相关。本研究的结果将为来自 MENA 地区的移民人群的糖尿病护理提供信息。
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