美国按种族和族裔进行糖尿病筛查：等效体重指数和年龄阈值。

Diabetes Screening by Race and Ethnicity in the United States: Equivalent Body Mass Index and Age Thresholds.

机构信息

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (R.A., R.W.Y., N.C., R.K.W., D.S.K.).

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (K.B.).

出版信息

Ann Intern Med. 2022 Jun;175(6):765-773. doi: 10.7326/M20-8079. Epub 2022 May 10.

DOI:10.7326/M20-8079

PMID:35533384

Abstract

BACKGROUND

Racial/ethnic minority populations in the United States have increased rates of diabetes compared with White populations. The 2021 guidelines from the U.S. Preventive Services Task Force recommend diabetes screening for adults aged 35 to 70 years with a body mass index (BMI) of 25 kg/m or greater.

OBJECTIVE

To determine the BMI threshold for diabetes screening in major racial/ethnic minority populations with benefits and harms equivalent to those of the current diabetes screening threshold in White adults.

DESIGN

Cross-sectional study.

SETTING

NHANES (National Health and Nutrition Examination Survey), 2011 to 2018.

PARTICIPANTS

Nonpregnant U.S. adults aged 18 to 70 years ( = 19 335).

MEASUREMENTS

A logistic regression model was used to estimate diabetes prevalence at various BMIs for White, Asian, Black, and Hispanic Americans. For each racial/ethnic minority group, the equivalent BMI threshold was defined as the BMI at which the prevalence of diabetes in 35-year-old persons in that group is equal to that in 35-year-old White adults at a BMI of 25 kg/m. Ranges were estimated to account for the uncertainty in prevalence estimates for White and racial/ethnic minority populations.

RESULTS

Among adults aged 35 years with a BMI of 25 kg/m, the prevalence of diabetes in Asian Americans (3.8% [95% CI, 2.8% to 5.1%]), Black Americans (3.5% [CI, 2.7% to 4.7%]), and Hispanic Americans (3.0% [CI, 2.1% to 4.2%]) was significantly higher than that in White Americans (1.4% [CI, 1.0% to 2.0%]). Compared with a BMI threshold of 25 kg/m in White Americans, the equivalent BMI thresholds for diabetes prevalence were 20 kg/m (range, <18.5 to 23 kg/m) for Asian Americans, less than 18.5 kg/m (range, <18.5 to 23 kg/m) for Black Americans, and 18.5 kg/m (range, <18.5 to 24 kg/m) for Hispanic Americans.

LIMITATION

Sample size limitations precluded assessment of heterogeneity within racial/ethnic groups.

CONCLUSION

Among U.S. adults aged 35 years or older, offering diabetes screening to Black Americans and Hispanic Americans with a BMI of 18.5 kg/m or greater and Asian Americans with a BMI of 20 kg/m or greater would be equivalent to screening White adults with a BMI of 25 kg/m or greater. Using screening thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis.

PRIMARY FUNDING SOURCE

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

摘要

背景

与白人相比，美国的少数族裔人群糖尿病发病率更高。美国预防服务工作组 2021 年的指南建议，对 BMI 为 25kg/m²或更高的 35 至 70 岁成年人进行糖尿病筛查。

目的

确定主要少数族裔人群中用于糖尿病筛查的 BMI 阈值，其在获益和危害方面与白人成年人目前的糖尿病筛查阈值相当。

设计

横断面研究。

地点

NHANES（国家健康和营养检查调查），2011 年至 2018 年。

参与者

18 至 70 岁的非怀孕美国成年人（n=19335）。

测量

使用逻辑回归模型估计各种 BMI 下白种人、亚洲人、黑人和西班牙裔美国人的糖尿病患病率。对于每个少数族裔群体，等效 BMI 阈值定义为该群体中 35 岁人群的糖尿病患病率与 BMI 为 25kg/m²的白种人 35 岁人群的糖尿病患病率相等的 BMI。为了考虑白种人和少数族裔人群的患病率估计的不确定性，对范围进行了估计。

结果

在 BMI 为 25kg/m²的 35 岁成年人中，亚洲人（3.8%[95%CI，2.8%至 5.1%]）、黑人（3.5%[CI，2.7%至 4.7%]）和西班牙裔美国人（3.0%[CI，2.1%至 4.2%]）的糖尿病患病率显著高于白人（1.4%[CI，1.0%至 2.0%]）。与白种人 BMI 阈值 25kg/m²相比，亚洲人糖尿病患病率的等效 BMI 阈值为 20kg/m²（范围，<18.5 至 23kg/m²），黑人的 BMI 阈值<18.5kg/m²（范围，<18.5 至 23kg/m²），西班牙裔美国人的 BMI 阈值为 18.5kg/m²（范围，<18.5 至 24kg/m²）。