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Health Inequality in Eight Adverse Outcomes Over a 25-Year Period in a Multi-Ethnic Population in New Zealand Population with Impaired Glucose Tolerance and/or Impaired Fasting Glucose: An Age-Period-Cohort Analysis

Wang, Zheng; Yu, Dahai; Osuagwu, Uchechukwu Levi; Pickering, Karen; Baker, John; Cutfield, Richard; Cai, Yamei; Sundborn, Gerhard; Zhao, Zhanzheng; Simmons, David

Authors

Zheng Wang

Uchechukwu Levi Osuagwu

Karen Pickering

John Baker

Richard Cutfield

Yamei Cai

Gerhard Sundborn

Zhanzheng Zhao

David Simmons



Abstract

Purpose: We aimed to examine socioeconomic inequality (SI) in cause-specific outcomes among adults with impaired glucose tolerance (IGT) and/or Impaired fasting glucose (IFG) in New Zealand (NZ) over 25 years.

Patients and Methods: A population-based open cohort was derived from Diabetes Care Support Service in NZ with national databases linkage. Patients aged ≥ 18 years with IGT and/or IFG were enrolled between 01/01/1994 and 31/07/2018 and followed up until death or 31/12/2018. Incident outcomes (all-cause, premature, cardiovascular, and cancer death; cardiovascular, myocardial infarction, stroke, heart failure, and end-stage kidney disease hospitalization) by demographic, anthropometric, socioeconomic status, clinical measurements, enrol-time-periods, and IGT/IFG were evaluated. Adjusted incidence rate ratios, absolute risk difference, and SI measurements (slope and relative index of inequality) were estimated using Age-Period-Cohort models.

Results: 29,894 patients (58.5 (SD 14.3) years mean age; 52.2% female) were enrolled with 5.6 (IQR: 4.4– 7.4) years of median follow-up. Mortality rates decreased, whereas hospitalization (except myocardial infarction) rates increased. SI was significant for each outcome. Higher mortality and hospitalization rates and worsened SI were common in men, older, the most deprived, and Māori patients, as well as patients with obesity, current smoking, with both IFG and IGT, and greater metabolic derangement (higher systolic blood pressure, lipids, and HbA1c, and lower level of mean arterial pressure).

Conclusion: Enhanced management strategies are necessary for people with IGT and/or IFG to address persisting SI, especially for men, older people, current smokers, NZ European and Māori patients, patients with obesity, or with any abnormal metabolic measurements.

Citation

Wang, Z., Yu, D., Osuagwu, U. L., Pickering, K., Baker, J., Cutfield, R., Cai, Y., Orr-Walker, B. J., Sundborn, G., Zhao, Z., & Simmons, D. (2023). Health Inequality in Eight Adverse Outcomes Over a 25-Year Period in a Multi-Ethnic Population in New Zealand Population with Impaired Glucose Tolerance and/or Impaired Fasting Glucose: An Age-Period-Cohort Analysis. Clinical Epidemiology, 15, 1123-1143. https://doi.org/10.2147/clep.s433714

Journal Article Type Article
Acceptance Date Nov 23, 2023
Online Publication Date Dec 6, 2023
Publication Date 2023-12
Deposit Date Dec 10, 2023
Journal Clinical Epidemiology
Print ISSN 1179-1349
Publisher Dove Press
Peer Reviewed Peer Reviewed
Volume 15
Pages 1123-1143
DOI https://doi.org/10.2147/clep.s433714
Keywords impaired glucose tolerance, cancer, Māori, socioeconomic inequality, New Zealand, mortality, cardiovascular diseases, ethnic disparity, impaired fasting glucose, heart failure, end-stage renal disease
Public URL https://keele-repository.worktribe.com/output/666050
Publisher URL https://www.dovepress.com/health-inequality-in-eight-adverse-outcomes-over-a-25-year-period-in-a-peer-reviewed-fulltext-article-CLEP