In the Journals

Less exercise and education, nonwhite ethnicity may increase diabetes, hypertension risk

Nonwhite adults who do not exercise frequently or do not have a college degree and live in impoverished neighborhoods are more likely to develop diabetes and hypertension compared with those with different sociodemographic characteristics, according to findings presented in JAMA Network Open.

Matthew S. Pantell, MD, MS

“As social and behavioral factors have been shown to be associated with health outcomes, health care systems are becoming increasingly interested in collecting this information to help inform care. A National Academy of Medicine (NAM) report in 2014 recommended a panel of social and behavioral domains for incorporation into electronic health records to aid in patient care and population health management,” Matthew S. Pantell, MD, MS, an assistant professor in the division of pediatric hospital medicine at the Center for Health and Community and UCSF Preterm Birth Initiative at the University of California, San Francisco, told Endocrine Today. “This research is important because it examined how most of these NAM-recommended domains — as well as the cumulative risk of multiple domains — are helpful in predicting disease onset in a clinical population, supporting the value of assessing these risk factors.”

Pantell and colleagues conducted a prospective cohort study in which they identified 18,133 adults without hypertension (mean age, 48.1 years; 60.6% women) and 35,788 without diabetes (mean age, 56.2 years; 56.4% women) who completed sociodemographic surveys between 2005 and 2016 as members of Kaiser Permanente Northern California. Surveys were sent every 3 years, and the researchers were able to assess the development of diabetes and/or hypertension 3 years after survey completion based on linked electronic health records.

Sociodemographic factors included for analysis were race/ethnicity, education level; financial stress; general stress; whether a participant was married, singled, separated, divorced or widowed; incidence of domestic violence; depressive symptoms; exercise frequency; smoking and alcohol consumption status; and the number of households in a participant’s neighborhood that were considered below the poverty line, which was ascertained from the American Community Survey.

Hypertension risk factors

At 3 years, the researchers observed that 1,163 participants without hypertension at baseline had the condition (6.4%). Participants who were of Asian (HR = 1.55; 95% CI, 1.31-1.84), Hispanic (HR = 1.28; 95% CI, 1.05-1.56) or black (HR = 1.5; 95% CI, 1.16-1.92) ethnicities were more likely to develop hypertension compared with those of white ethnicity. In addition, compared with those with at least a college degree, those who had some college (HR = 1.4; 95% CI, 1.23-1.6) or high school (HR = 1.53; 95% CI, 1.29-1.81) or less than a high school education (HR = 1.84; 95% CI, 1.4-2.43) were at greater risk for the condition. Other risk factors that made hypertension more likely included being widowed (HR = 1.38; 95% CI, 1.11-1.71), living in an impoverished neighborhood (HR = 1.26; 95% CI, 1-1.59), exercising infrequently (HR = 1.22; 95% CI, 1.08-1.38) and smoking (HR = 1.35; 95% CI, 1.1-1.67).

Diabetes risk factors

The researchers also found that 1,442 of those without diabetes at baseline had the disease at 3 years (4%) and that participants of Asian (HR = 2.31; 95% CI, 1.98-2.69), Hispanic (HR = 1.46; 95% CI, 1.22-1.74), black (HR = 1.27; 95% CI, 1.03-1.57) and other (HR = 1.57; 95% CI, 1.17-2.12) ethnicities were more likely to develop the condition than those of white ethnicity. Having a maximum educational level of less than high school (HR = 1.58; 95% CI, 1.26-1.97), high school (HR = 1.47; 95% CI, 1.27-1.7) or some college (HR = 1.39; 95% CI, 1.22-1.58) increased the risk for diabetes compared with those with a college degree or more. Other factors that were associated with higher diabetes risk included being single or separated (HR = 1.24; 95% CI, 1.08-1.42), experiencing high stress (HR = 1.28; 95% CI, 1.09-1.51), reporting domestic abuse (HR = 1.68; 95% CI, 1.14-2.48), depressive symptoms (HR = 1.28; 95% CI, 1.1-1.5), living in an impoverished neighborhood (HR = 1.31; 95% CI, 1.07-1.6), exercising infrequently (HR = 1.35; 95% CI, 1.21-1.5) and smoking (HR = 1.53; 95% CI, 1.26-1.86).

Comorbidity risk factors

Both hypertension (HR = 1.41; 95% CI, 1.17-1.71) and diabetes (HR = 1.53; 95% CI, 1.29-1.82) were most likely to develop in those who met the requirements for at least three of the sociodemographic factors associated with increased risk compared with those who did not meet any factors, the researchers reported.

“Both individual and cumulative social and behavioral risk factors are associated with earlier onset of disease, so clinicians and health systems should consider collecting this information in clinical settings to help inform clinical practice and population health management,” Pantell said. “Clinicians and health care systems should consider obtaining information on social and behavioral factors from patients in order to help identify high-risk patients and target interventions.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

Nonwhite adults who do not exercise frequently or do not have a college degree and live in impoverished neighborhoods are more likely to develop diabetes and hypertension compared with those with different sociodemographic characteristics, according to findings presented in JAMA Network Open.

Matthew S. Pantell, MD, MS

“As social and behavioral factors have been shown to be associated with health outcomes, health care systems are becoming increasingly interested in collecting this information to help inform care. A National Academy of Medicine (NAM) report in 2014 recommended a panel of social and behavioral domains for incorporation into electronic health records to aid in patient care and population health management,” Matthew S. Pantell, MD, MS, an assistant professor in the division of pediatric hospital medicine at the Center for Health and Community and UCSF Preterm Birth Initiative at the University of California, San Francisco, told Endocrine Today. “This research is important because it examined how most of these NAM-recommended domains — as well as the cumulative risk of multiple domains — are helpful in predicting disease onset in a clinical population, supporting the value of assessing these risk factors.”

Pantell and colleagues conducted a prospective cohort study in which they identified 18,133 adults without hypertension (mean age, 48.1 years; 60.6% women) and 35,788 without diabetes (mean age, 56.2 years; 56.4% women) who completed sociodemographic surveys between 2005 and 2016 as members of Kaiser Permanente Northern California. Surveys were sent every 3 years, and the researchers were able to assess the development of diabetes and/or hypertension 3 years after survey completion based on linked electronic health records.

Sociodemographic factors included for analysis were race/ethnicity, education level; financial stress; general stress; whether a participant was married, singled, separated, divorced or widowed; incidence of domestic violence; depressive symptoms; exercise frequency; smoking and alcohol consumption status; and the number of households in a participant’s neighborhood that were considered below the poverty line, which was ascertained from the American Community Survey.

Hypertension risk factors

At 3 years, the researchers observed that 1,163 participants without hypertension at baseline had the condition (6.4%). Participants who were of Asian (HR = 1.55; 95% CI, 1.31-1.84), Hispanic (HR = 1.28; 95% CI, 1.05-1.56) or black (HR = 1.5; 95% CI, 1.16-1.92) ethnicities were more likely to develop hypertension compared with those of white ethnicity. In addition, compared with those with at least a college degree, those who had some college (HR = 1.4; 95% CI, 1.23-1.6) or high school (HR = 1.53; 95% CI, 1.29-1.81) or less than a high school education (HR = 1.84; 95% CI, 1.4-2.43) were at greater risk for the condition. Other risk factors that made hypertension more likely included being widowed (HR = 1.38; 95% CI, 1.11-1.71), living in an impoverished neighborhood (HR = 1.26; 95% CI, 1-1.59), exercising infrequently (HR = 1.22; 95% CI, 1.08-1.38) and smoking (HR = 1.35; 95% CI, 1.1-1.67).

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Diabetes risk factors

The researchers also found that 1,442 of those without diabetes at baseline had the disease at 3 years (4%) and that participants of Asian (HR = 2.31; 95% CI, 1.98-2.69), Hispanic (HR = 1.46; 95% CI, 1.22-1.74), black (HR = 1.27; 95% CI, 1.03-1.57) and other (HR = 1.57; 95% CI, 1.17-2.12) ethnicities were more likely to develop the condition than those of white ethnicity. Having a maximum educational level of less than high school (HR = 1.58; 95% CI, 1.26-1.97), high school (HR = 1.47; 95% CI, 1.27-1.7) or some college (HR = 1.39; 95% CI, 1.22-1.58) increased the risk for diabetes compared with those with a college degree or more. Other factors that were associated with higher diabetes risk included being single or separated (HR = 1.24; 95% CI, 1.08-1.42), experiencing high stress (HR = 1.28; 95% CI, 1.09-1.51), reporting domestic abuse (HR = 1.68; 95% CI, 1.14-2.48), depressive symptoms (HR = 1.28; 95% CI, 1.1-1.5), living in an impoverished neighborhood (HR = 1.31; 95% CI, 1.07-1.6), exercising infrequently (HR = 1.35; 95% CI, 1.21-1.5) and smoking (HR = 1.53; 95% CI, 1.26-1.86).

Comorbidity risk factors

Both hypertension (HR = 1.41; 95% CI, 1.17-1.71) and diabetes (HR = 1.53; 95% CI, 1.29-1.82) were most likely to develop in those who met the requirements for at least three of the sociodemographic factors associated with increased risk compared with those who did not meet any factors, the researchers reported.

“Both individual and cumulative social and behavioral risk factors are associated with earlier onset of disease, so clinicians and health systems should consider collecting this information in clinical settings to help inform clinical practice and population health management,” Pantell said. “Clinicians and health care systems should consider obtaining information on social and behavioral factors from patients in order to help identify high-risk patients and target interventions.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.