Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Lancet. 2023 Jul 15;402(10397):235-249. doi: 10.1016/S0140-6736(23)00909-1. Epub 2023 Jun 22.
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
糖尿病普遍存在，其患病率呈指数级增长，在全球范围内超过了大多数疾病。在本系列论文中，我们使用新的理论框架和对现有文献的叙述性回顾，展示了结构性不平等（结构性种族主义和地理不平等）如何加速了全球糖尿病疾病、发病率和死亡率的上升。我们讨论了结构性不平等如何导致关键的、上游的健康社会决定因素的巨大、固定差异，这些差异影响下游的健康社会决定因素，并导致糖尿病结果在不平等的扩大中呈级联式加剧。我们审查了已知对糖尿病结果有影响的社会决定因素类别，包括公众意识和政策、经济发展、获得高质量护理、糖尿病管理创新以及社会文化规范。我们还提供了基于我们理论框架的区域观点，以突出突出的、现实世界的挑战。
