Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Background Social determinants of health (SDOH) have been associated with diabetes risk; however, their association with cardiovascular disease (CVD) events in individuals with diabetes is poorly described. We hypothesized that a greater number of SDOH among individuals with diabetes would be associ...
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| Language: | English |
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Korean Diabetes Association
2024-11-01
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| Series: | Diabetes & Metabolism Journal |
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| Online Access: | http://e-dmj.org/upload/pdf/dmj-2023-0380.pdf |
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| _version_ | 1846150003492388864 |
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| author | Lisa Zhang Evgeniya Reshetnyak Joanna B. Ringel Laura C. Pinheiro April Carson Doyle M. Cummings Raegan W. Durant Gargya Malla Monika M. Safford |
| author_facet | Lisa Zhang Evgeniya Reshetnyak Joanna B. Ringel Laura C. Pinheiro April Carson Doyle M. Cummings Raegan W. Durant Gargya Malla Monika M. Safford |
| author_sort | Lisa Zhang |
| collection | DOAJ |
| description | Background Social determinants of health (SDOH) have been associated with diabetes risk; however, their association with cardiovascular disease (CVD) events in individuals with diabetes is poorly described. We hypothesized that a greater number of SDOH among individuals with diabetes would be associated with a higher risk of CVD events. Methods The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national, biracial cohort of 30,239 individuals ≥45 years old recruited in 2003–2007. We included 6,322 participants with diabetes at baseline, defined as healthcare professional diagnosis, diabetes medication use, or blood glucose values. Seven SDOH that were individually associated with CVD events were included (P<0.20). The outcome was CVD events, a composite of expert-adjudicated myocardial infarction, stroke, or cardiovascular death. We estimated Cox proportional hazard models to examine associations between number of SDOH (0, 1, 2, ≥3) and CVD events. Results In an age and sex adjusted model, the presence of multiple SDOH significantly increased the risk of any CVD event (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.26 to 1.74 for two SDOH; HR, 1.68; 95% CI, 1.43 to 1.96 for ≥3 SDOH). This finding was attenuated but remained statistically significant in a fully adjusted model (HR, 1.19; 95% CI, 1.01 to 1.40 for two SDOH; HR, 1.27; 95% CI, 1.07 to 1.50 for ≥3 SDOH). Conclusion Having multiple SDOH was independently associated with an increased risk of CVD events, a finding driven by cardiovascular death. Identifying individuals with diabetes who have multiple SDOH may be helpful for detecting those at higher risk of experiencing or dying from CVD events. |
| format | Article |
| id | doaj-art-01d1c97046e84a1e94468f078b989f9c |
| institution | Kabale University |
| issn | 2233-6079 2233-6087 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Korean Diabetes Association |
| record_format | Article |
| series | Diabetes & Metabolism Journal |
| spelling | doaj-art-01d1c97046e84a1e94468f078b989f9c2024-11-29T06:51:01ZengKorean Diabetes AssociationDiabetes & Metabolism Journal2233-60792233-60872024-11-014861073108310.4093/dmj.2023.03802857Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) StudyLisa Zhang0Evgeniya Reshetnyak1Joanna B. Ringel2Laura C. Pinheiro3April Carson4Doyle M. Cummings5Raegan W. Durant6Gargya Malla7Monika M. Safford8 Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Department of Medicine, University of Arizona, Tucson, AZ, USA Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USABackground Social determinants of health (SDOH) have been associated with diabetes risk; however, their association with cardiovascular disease (CVD) events in individuals with diabetes is poorly described. We hypothesized that a greater number of SDOH among individuals with diabetes would be associated with a higher risk of CVD events. Methods The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national, biracial cohort of 30,239 individuals ≥45 years old recruited in 2003–2007. We included 6,322 participants with diabetes at baseline, defined as healthcare professional diagnosis, diabetes medication use, or blood glucose values. Seven SDOH that were individually associated with CVD events were included (P<0.20). The outcome was CVD events, a composite of expert-adjudicated myocardial infarction, stroke, or cardiovascular death. We estimated Cox proportional hazard models to examine associations between number of SDOH (0, 1, 2, ≥3) and CVD events. Results In an age and sex adjusted model, the presence of multiple SDOH significantly increased the risk of any CVD event (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.26 to 1.74 for two SDOH; HR, 1.68; 95% CI, 1.43 to 1.96 for ≥3 SDOH). This finding was attenuated but remained statistically significant in a fully adjusted model (HR, 1.19; 95% CI, 1.01 to 1.40 for two SDOH; HR, 1.27; 95% CI, 1.07 to 1.50 for ≥3 SDOH). Conclusion Having multiple SDOH was independently associated with an increased risk of CVD events, a finding driven by cardiovascular death. Identifying individuals with diabetes who have multiple SDOH may be helpful for detecting those at higher risk of experiencing or dying from CVD events.http://e-dmj.org/upload/pdf/dmj-2023-0380.pdfcardiovascular diseasesdiabetes mellitusmyocardial infarctionsocial determinants of healthstroke |
| spellingShingle | Lisa Zhang Evgeniya Reshetnyak Joanna B. Ringel Laura C. Pinheiro April Carson Doyle M. Cummings Raegan W. Durant Gargya Malla Monika M. Safford Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study Diabetes & Metabolism Journal cardiovascular diseases diabetes mellitus myocardial infarction social determinants of health stroke |
| title | Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study |
| title_full | Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study |
| title_fullStr | Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study |
| title_full_unstemmed | Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study |
| title_short | Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study |
| title_sort | social determinants of health and cardiovascular risk among adults with diabetes the reasons for geographic and racial differences in stroke regards study |
| topic | cardiovascular diseases diabetes mellitus myocardial infarction social determinants of health stroke |
| url | http://e-dmj.org/upload/pdf/dmj-2023-0380.pdf |
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