Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
Discover Momenta, Woodstock, UK.
Int J Behav Med. 2023 Dec;30(6):904-913. doi: 10.1007/s12529-022-10146-x. Epub 2023 Jan 11.
Weight loss in diabetes prevention programmes has been shown to be associated with participants' age, socio-economic status, and ethnicity. However, little is known about how these differences relate to attendance and whether such differences can be mediated by other potentially modifiable factors. Differential effectiveness across these factors may exacerbate health inequalities.
Prospective analysis of participant data collected by one provider of the standardised national NHS diabetes prevention programme in England. Mediation analysis was performed via a structural equation model to examine whether the number of attended sessions mediated the associations of age, socio-economic status, and ethnicity with follow-up weight. The group-level factor of number of attended sessions was examined using multiple linear regression as a benchmark; multilevel linear regression using three levels (venue, coach, and group); and fixed effects regression to account for venue-specific and coach-specific characteristics.
The associations of age, socio-economic status, and ethnicity with follow-up weight were all mediated by the number of attended sessions. Group size was associated with attendance in an inverted 'U' shape, and the number of days between referral and group start was negatively associated with attendance. Time of day, day of the week, and the number of past groups led by the coach were not associated with attendance.
Most of the differences in weight loss initially attributed to socio-demographic factors are mediated by the attendance of the diabetes prevention programme. Therefore, targeted efforts to improve uptake and adherence to such programmes may help alleviate inequalities.
糖尿病预防计划中的体重减轻与参与者的年龄、社会经济地位和种族有关。然而，对于这些差异与出勤率的关系以及这些差异是否可以通过其他潜在的可调节因素来调节，知之甚少。这些因素的差异可能会加剧健康不平等。
对英格兰国家国民保健制度糖尿病预防计划的一个提供者收集的参与者数据进行前瞻性分析。通过结构方程模型进行中介分析，以检查参加次数与随访体重的关联是否受到年龄、社会经济地位和种族的影响。使用多元线性回归作为基准来检查组级因素参加次数；使用三个级别（场地、教练和组）进行多层次线性回归；并使用固定效应回归来考虑特定场地和教练的特征。
年龄、社会经济地位和种族与随访体重的关联均通过参加次数来调节。组规模与出勤率呈倒“U”形相关，而从转诊到小组开始之间的天数与出勤率呈负相关。时间、星期几和教练领导的过去小组数量与出勤率无关。
最初归因于社会人口因素的体重减轻差异大多可通过参加糖尿病预防计划来调节。因此，有针对性地努力提高此类计划的参与率和坚持率可能有助于减轻不平等。
