Fouotsa Noé Carème Manfouo, Ndjaboue Ruth, Ngueta Gerard
CHU de Sherbrooke Research Center, DOCC (Diabetes, Obesity and Cardiovasvascular Complications), CRCHUS-Hôpital Fleurimont, 12Eme Avenue Nord, Sherbrooke, Québec, 3001, Canada.
Canada Research Chair in Inclusivity and Active Ageing, University of Sherbrooke, Sherbrooke, Canada.
J Racial Ethn Health Disparities. 2025 Jun;12(3):1482-1490. doi: 10.1007/s40615-024-01980-8. Epub 2024 Mar 21.
Among US adults aged 20 + years in the USA with previously diagnosed type 2 diabetes mellitus (T2DM), we aimed to estimate the prevalence of early-onset T2DM (onset at age < 50.5 years) and to test associations between early-onset T2DM and race/ethnicity, and other hypothesized predictors.
We pooled data from the annual National Health and Nutrition Examination Surveys (NHANES) over the years 2001 through 2018. We tested hypotheses of association and identified predictors using stepwise logistic regression analysis, and 11 supervised machine learning classification algorithms.
After appropriate weighting, we estimated that among adults in the USA aged 20 + years with previously diagnosed T2DM, the prevalence of early-onset was 52.9% (95% confidence intervals, 49.6 to 56.2%). Among Non-Hispanic Whites (NHW) the prevalence was 48.6% (95% CI, 44.6 to 52.6%), among Non-Hispanic Blacks: 56.9% (95% CI, 51.8 to 62.0%), among Hispanics: 62.7% (95% CI, 53.2 to 72.3%). In the final multivariable logistic regression model, the top-3 markers predicting early-onset T2DM in males were NHB ethnicity (OR = 2.97; 95% CI: 2.24-3.95) > tobacco smoking (OR = 2.79; 95% CI: 2.18-3.58) > high education level (OR = 1.65; 95% CI: 1.27-2.14) in males. In females, the ranking was tobacco smoking (OR = 2.59; 95% CI: 1.90-3.53) > Hispanic ethnicity (OR = 1.49; 95% CI: 1.08-2.05) > obesity (OR = 1.30; 95% CI: 0.91-1.86) in females. The acculturation score emerged from the machine learning approach as the dominant marker explaining the race disparity in early-onset T2DM.
The prevalence of early-onset T2DM was higher among NHB and Hispanic people, than among NHW people. Independently of race/ethnicity, acculturation, tobacco smoking, education level, marital status, obesity, and hypertension were also predictive.
在美国20岁及以上先前已确诊2型糖尿病（T2DM）的成年人中，我们旨在估计早发型T2DM（发病年龄<50.5岁）的患病率，并检验早发型T2DM与种族/族裔以及其他假设预测因素之间的关联。
我们汇总了2001年至2018年年度全国健康与营养检查调查（NHANES）的数据。我们使用逐步逻辑回归分析和11种监督式机器学习分类算法检验关联假设并确定预测因素。
经过适当加权后，我们估计在美国20岁及以上先前已确诊T2DM的成年人中，早发型的患病率为52.9%（95%置信区间，49.6至56.2%）。在非西班牙裔白人（NHW）中患病率为48.6%（95%CI，44.6至52.6%），在非西班牙裔黑人中为56.9%（95%CI，51.8至62.0%），在西班牙裔中为62.7%（95%CI，53.2至72.3%）。在最终的多变量逻辑回归模型中，预测男性早发型T2DM的前三大指标是NHB族裔（OR = 2.97；95%CI：2.24 - 3.95）>吸烟（OR = 2.79；95%CI：2.18 - 3.58）>男性高教育水平（OR = 1.65；95%CI：1.27 - 2.14）。在女性中，排名为吸烟（OR = 2.59；95%CI：1.90 - 3.53）>西班牙裔族裔（OR = 1.49；95%CI：1.08 - 2.05）>女性肥胖（OR = 1.30；95%CI：0.91 - 1.86）。机器学习方法得出的文化适应得分是解释早发型T2DM种族差异的主要指标。
NHB和西班牙裔人群中早发型T2DM的患病率高于NHW人群。独立于种族/族裔，文化适应、吸烟、教育水平、婚姻状况、肥胖和高血压也具有预测性。
