Yu Dahai, Osuagwu Uchechukwu Levi, Pickering Karen, Baker John, Cutfield Richard, Wang Zheng, Cai Yamei, Orr-Walker Brandon J, Sundborn Gerhard, Zhao Zhanzheng, Simmons David
Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.
Clin Epidemiol. 2023 May 1;15:511-523. doi: 10.2147/CLEP.S402307. eCollection 2023.
PURPOSE: The study aimed to examine the separate population-level contributions of the ethnic and socioeconomic disparities among people with type 2 diabetes mellitus (T2DM) and residence in New Zealand (NZ). PATIENTS AND METHODS: A prospective cohort enrolled T2DM patients from 01/01/1994 into the Diabetes Care Support Service, a primary care audit program in Auckland, NZ. The cohort was linked to national registry databases (socioeconomic status, pharmaceutical claim, hospitalization, and death registration). Each cohort member was followed up till death or the study end time (31/12/2019), whichever came first. Incident clinical events (stroke, myocardial infarction (MI), heart failure (HF), end-stage renal disease (ESRD), and premature mortality (PM)) were used as outcomes. The attributable fractions (AFs) were estimated for the whole population and for specific population with NZ Europeans (NZE) and/or least deprived population as reference, both unadjusted and with adjustment for covariables by Cox Regression models. RESULTS: Among 36,267 patients, adjusted population AFs indicated 6.6(-30.8-33.3)% of PM, 17.1(5.8-27.0)% of MI, 35.3(22.6-46.0)% of stroke, 14.3(3.2-24.2)% of HF, and 15.9(6.7-24.2)% of ESRD could be attributed to deprivation; while 14.3(3.3-25.4)% of PM, -3.3(-8.3-1.5)% of MI, -0.5(-6.7-5.3)% of stroke, 4.7(0.3-8.8)% of HF, 13.3(9.9-16.6)% of ESRD could be attributed to ethnicity. Deprivation contributed a significant AF to stroke, while ethnicity was important for ESRD. Gradient of AF for deprivation indicated NZE and Asians were most affected by deprivation across outcomes. Conversely, Māori, with the highest AFs for ethnicity of PM and ESRD, were unaffected by deprivation. At same deprivations, the AFs of MI and stroke were greatest among NZE compared with other ethnic groups; the AF of ESRD was greatest among Māori and Pasifika. CONCLUSION: Both socioeconomic deprivation and ethnicity are strongly associated with outcomes in patients with T2DM in NZ, although the extent of the deprivation gradient is greatest among NZE and Asians, and least among Māori.
目的：本研究旨在探讨新西兰（NZ）2型糖尿病（T2DM）患者中种族差异和社会经济差异在人群层面的单独影响。 患者与方法：一项前瞻性队列研究纳入了1994年1月1日起进入新西兰奥克兰初级保健审计项目糖尿病护理支持服务的T2DM患者。该队列与国家登记数据库（社会经济状况、药物报销、住院和死亡登记）相链接。对每位队列成员随访至死亡或研究结束时间（2019年12月31日），以先到者为准。将新发临床事件（中风、心肌梗死（MI）、心力衰竭（HF）、终末期肾病（ESRD）和过早死亡（PM））作为研究结局。以新西兰欧洲人（NZE）和/或最不贫困人群为参照，通过Cox回归模型分别对全人群以及特定人群估计未调整和经协变量调整后的归因分数（AFs）。 结果：在36267例患者中，调整后的人群AFs显示，PM的6.6%（-30.8%-33.3%）、MI的17.1%（5.8%-27.0%）、中风的35.3%（22.6%-46.0%）、HF的14.3%（3.2%-24.2%）以及ESRD的15.9%（6.7%-24.2%）可归因于贫困；而PM的14.3%（3.3%-25.4%）、MI的-3.3%（-8.3%-1.5%）、中风的-0.5%（-6.7%-5.3%）、HF的4.7%（0.3%-8.8%）以及ESRD的13.3%（9.9%-16.6%）可归因于种族。贫困对中风的AF贡献显著，而种族对ESRD很重要。贫困的AF梯度表明，NZE和亚洲人在所有结局中受贫困影响最大。相反，PM和ESRD种族AF最高的毛利人不受贫困影响。在相同贫困程度下，与其他种族相比，NZE中MI和中风的AF最大；毛利人和太平洋岛民中ESRD的AF最大。 结论：在新西兰，社会经济贫困和种族均与T2DM患者的结局密切相关，尽管贫困梯度在NZE和亚洲人中最大，在毛利人中最小。
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