Eugene S. Tull

Markedly increased renal disease mortality and incidence of renal replacement therapy among IDDM patients in Japan in contrast to Allegheny County, Pennsylvania, USA

SummaryThe aim of this study was to evaluate factors related to the markedly increased risk of dying from diabetic renal disease in Japanese insulin-dependent diabetic patients compared to those in the USA. The study was based on two population-based cohorts consisting of 1374 cases from Japan and 995 cases from Allegheny County, Pennsylvania, USA, who were diagnosed between 1 January 1965 and 31 December 1979. The living status and dialysis experience were determined as of 1 January 1990. The duration-adjusted renal-failure-related mortality rates in the Japanese cohort and the USA cohort were 277.2 and 130.9 per 100,000 person-years, and the duration-adjusted incidence rates of dialysis were 564.9 and 295.6 per 100,000 person-years, respectively. After adjustment for sex, age at onset, calendar year of onset, and duration of diabetes, individuals with insulin-dependent diabetes in the Japanese cohort were still 2.4-fold more likely to receive dialysis compared to those in the USA cohort. Ten of the 36 renal-failure-related deaths in the Japanese cohort had never been treated by dialysis, while all renal-failure-related deaths in the USA cohort had been treated by dialysis. Survival after initiation of dialysis in the Japanese cohort was virtually the same as the USA cohort. These data suggest that a greater frequency of diabetic end-stage renal disease and reduced access to acceptance at dialysis underlie much of the excess of diabetic renal deaths in Japan.

A Twofold Excess Mortality Among Black Compared With White IDDM Patients in Allegheny County, Pennsylvania

OBJECTIVE To examine the long-term mortality experience of blacks who develop IDDM in childhood. RESEARCH DESIGN AND METHODS The 11–25-year mortality status of individuals with IDDM who participated in the Diabetes Epidemiology Research International (DERI) Mortality Study was verified as of 1 January 1990 for 1,008 (94%) of the 1,076 individuals in the study. Life-table analysis was performed, and race-specific rates were determined for the final sample. RESULTS Among black patients, 14.9% died compared with 6.6% of the white patients after a maximum of 25 years of follow-up. African-Americans experienced an age-adjusted mortality rate that was over twice that of whites for the entire period (9.4 vs. 3.8 per 1,000 person-years, respectively; P < 0.05) and at each 5-year interval of follow-up. Among blacks, the mortality rate for females (15.9/1,000 person-years) was 8.4 times (P < 0.05) that of males (1.9/1,000 person-years). In contrast, this sex difference was not seen among whites. Acute complications of diabetes accounted for 40% of the mortality in the black patients, while only 23% of the white patients died from acute causes. CONCLUSIONS The data suggest that some of the excess mortality in black IDDM patients may be preventable.

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands

OBJECTIVES To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. METHODS In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. RESULTS The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%-25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%-39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.07-3.07)), high triglycerides (OR = 3.66 (95% CI = 2.18-6.15)), and low HDL-C (OR = 1.60 (95% CI = 1.04-2.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. CONCLUSIONS The frequency of the MS among Caribbean-born persons in the U. S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups.

Epidemiology of childhood IDDM in U.S. Virgin Islands from 1979 to 1988. Evidence of an epidemic in early 1980s and variation by degree of racial admixture.

Objective The epidemiology of insulin-dependent diabetes mellitus (IDDM) was evaluated in a predominantly black population in the U.S. Virgin Islands. Research Design and Methodsd Primary ascertainment of diabetic subjects was by retrospective review of hospital and clinic records, and IDDM was defined by Diabetes Epidemiology Research International Group criteria. Results For the period 1979–1988, 28 children < 15 yr of age were diagnosed with IDDM resulting in an average annual IDDM incidence rate (IR) of 7.5∕100,000 (95% confidence interval 4.7–10.3). A significant increase in IDDM incidence (P < 0.01) was observed when the IR rose to 28.4∕100,000 in 1984. White children had the highest IR (28.9∕100,000). The IR for Hispanics (7.2∕100,000) was slightly higher than that for blacks (5.9∕100,000). Among black children, a slight but nonsignificant male excess in incidence was observed (male-female ratio 1.5). When black or Hispanic patients were compared with age-matched control subjects with respect to grandparental race, the diabetic subjects had a greater percentage of white ancestry (P < 0.02 and P < 0.05, respectively). The incidence of IDDM in Caribbean blacks (West Indians) in the U.S. Virgin Islands was similar to blacks in the U.S. Conclusions The epidemic of IDDM in 1984 provides support for a possible pandemic in the early 1980s.

Incidence of type 1 and type 2 diabetes in youth in the US Virgin Islands, 2001–2010

To report the annual incidence of type 1 and type 2 diabetes among youth and to describe characteristics of youth diagnosed with diabetes in the US Virgin Islands (USVI).

All-cause mortality in a population-based type 1 diabetes cohort in the U.S. Virgin Islands.

OBJECTIVE Type 1 diabetes remains a significant source of premature mortality; however, its burden has not been assessed in the U.S. Virgin Islands (USVI). As such, the objective of this study was to estimate type 1 diabetes mortality in a population-based registry sample in the USVI. RESEARCH DESIGN AND METHODS We report overall and 20-year mortality in the USVI Childhood (<19 years old) Diabetes Registry Cohort diagnosed 1979-2005. Recent data for non-Hispanic blacks from the Allegheny County, PA population-based type 1 diabetes registry were used to compare mortality in the USVI to the contiguous U.S. RESULTS As of December 31, 2010, the vital status of 94 of 103 total cases was confirmed (91.3%) with mean diabetes duration 16.8 ± 7.0 years. No deaths were observed in the 2000-2005 cohort. The overall mortality rates for those diagnosed 1979-1989 and 1990-1999 were 1852 and 782 per 100,000 person-years, respectively. Overall cumulative survival for USVI was 98% (95% CI: 97-99) at 10 years, 92% (95% CI: 89-95) at 15 years and 73% (95% CI: 66-80) at 20 years. The overall SMR for non-Hispanic blacks in the USVI was 5.8 (95% CI: 2.7-8.8). Overall mortality and cumulative survival for non-Hispanic blacks did not differ between the USVI and Allegheny County, PA. CONCLUSIONS This study, as the first type 1 diabetes mortality follow-up in the USVI, confirmed previous findings of poor disease outcomes in racial/ethnic minorities with type 1 diabetes.

Education and internalized racism in socio-political context: Zimbabwe and Swaziland

Abstract We focus on the scarcely researched concept of internalized racism (INR), conceptualized as the internalization by blacks of white stereotypes about blacks, to investigate the extent to which it is impacted by education. Samples were drawn from two countries in Southern Africa, Swaziland (N = 308) and Zimbabwe (N = 319). We examined the contrasting socio-political contexts of a history of apartheid in Zimbabwe, and the absence of de jure segregation in Swaziland, the levels of INR, and the relationship of education to INR in both societies. Analysis showed that there was no difference in the levels of INR. Education, our variable of main interest, was negatively related to INR in both societies, and age, and a “sense of helplessness” were positively related to INR also in both societies, although the latter was marginally significant in Swaziland. We discussed the unexpected similarity of INR levels in these societies, and the potential of education to mediate negative psychological effects in both socio-political contexts.

Understanding the relative influence of attitudes and societal norms on dietary intentions among African-Caribbean women

Abstract This study applies the theory of reasoned action (TRA) to understand the relative influence of personal attitude (AT) toward three chronic diseases (diabetes, heart disease, and hypertension), and social normative (SN) groups (family, friends, and church), toward intention to engage in dietary behaviors associated with obesity and chronic disease risk. The sample consists of N = 183 women, aged 18–55 years, in Barbados, West Indies, selected through a stratified cluster sample technique. The instrument includes demographic and anthropometric variables and components of the TRA. Analyses using structural equation modeling (SEM) indicate that the TRA explains 22%, 35% and 19% of the variances in intention to consume high-fat foods, alcohol, and fruits, nuts and vegetables, respectively. SN is a predictor of all three dietary intentions, while AT predicts only intention to eat fruit, nuts, and vegetables. In the models, social pressure from family is relatively more important than friends and church in influencing dietary intentions. It can be concluded that social normative influences have a stronger effect on intentions to consume fatty foods, alcohol, and fruit, nuts and vegetables than do personal attitudes.

Beyond Insulin-Dependent Diabetes Mellitus Registries: Capture-Recapture Approaches for Monitoring Incidence

Since 1980, the most important development in the area of childhood diabetes epidemiology has been the establishment of standardized registries for monitoring the incidence of the disease. In this paper, the evolution of the registries will be discussed, as well as concepts as to where the field should progress.

The differential gender effect of internalized racism on abdominal obesity in KwaZulu-Natal, South Africa

Abstract This research examined the effect of a psychosocial variable, internalized racism, on abdominal obesity, as measured by waist circumference. Results show that the effect of internalized racism on waist circumference persists net of other controls among women, but not among men. Also, among women who had high levels of internalized racism and high educational levels, a positive relationship to abdominal obesity is evident despite the tendency of education to be protective of abdominal obesity. This study supports other research findings that internalized racism is related to waist circumference among adult women but not among men in Western Hemisphere blacks. It also supports past research findings of a gendered reaction to psychosocial stress. It also illustrates that this relationship occurs on the continent of Africa, an area where research on this phenomenon is scarce.