Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon.
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Postgrad Med. 2023 Mar;135(2):169-178. doi: 10.1080/00325481.2023.2172283. Epub 2023 Feb 3.
BACKGROUND & OBJECTIVE: Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM.
Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains.
Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains.
This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.
全球 2 型糖尿病（T2DM）发病率不断上升，中东和北非（MENA）地区的发病率为全球第二高。包括黎巴嫩在内的 MENA 地区的人口也正在经历向西半球大规模移民的浪潮。关于健康的社会决定因素（SDOH）如何影响该人群的 T2DM 结局，目前仅有有限的数据。因此，本研究旨在评估 SDOH 与黎巴嫩 T2DM 成年人生活质量（QoL）之间的关系。
从黎巴嫩的初级保健中心招募了 300 名 T2DM 成年人。评估了人口统计学特征和世卫组织 QoL 领域（身体健康、心理健康、社会关系和环境）。SDOH 包括社会经济、邻里/建筑环境和心理社会变量。使用部分和完全调整的回归模型来检验 SDOH 与 QoL 领域之间的关联。
参与者的平均年龄为 60.3 岁，48%为女性，73%已婚，64%受教育程度低于高中。完全调整的回归模型结果表明，心理社会（即不良童年经历和抑郁）、社会经济（即就业、收入、家庭规模、保险、财务状况和财务独立）和邻里/建筑环境（即交通、家庭房间数量和某些家庭用品）变量是不同 QoL 领域的独立相关因素。
本研究表明，心理社会、社会经济和邻里/建筑环境变量与不同的 QoL 领域存在差异相关，这表明 SDOH 因素与黎巴嫩低收入 T2DM 成年人的生活质量密切相关。
