Aculturação e Diabetes

Diabetes Care 31:1621-1628, 2008 DOI: 10.2337/dc07-2182© 2008 by the American Diabetes Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Namratha R. Kandula, MD, MPH1, Ana V. Diez-Roux, MD, PHD2, Cheeling Chan, MS3, Martha L. Daviglus, MD, PHD3, Sharon A. Jackson, PHD4, Hanyu Ni, PHD, MPH5 and Pamela J. Schreiner, MS, PHD6
OBJECTIVE—The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non–Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
RESEARCH DESIGN AND METHODS—Diabetes was defined as fasting glucose 126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.
RESULTS—For non–Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non–Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14–5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.
CONCLUSIONS—Among non–Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined

Ministra Matilde: uma proposta

Prezada Ministra, acho que você já recebeu muitas pedradas pelo que disse, não disse e, que acharam que dissera. Agora, passada a tempestade, recomendo em prol da redução das desigualdades de cor, raça e etnia que solicite três audiências:

(1) ao ministro Paulo Bernardo (Planejamento), solicitando que pare de implicar com a área da saúde e retire os entraves á regulamentação da emenda constitucional número 29 e, repor o valor devido à Saúde com o novo cálculo do PIB;

(2) ao ministro Tarso Genro (Justiça), explicando que a repressão à violência interessa muito mais ao pobres e negros do que ao ricos e brancos, como muitos no governo federal adoram falar;

(3) ao seu chefe, sua Excelência, o Presidente da República para que entre para a história reduzindo a diferença de mortalidade entre negros, pardos e pretos. Para tanto, basta ordenar aos seus dois colegas de cima que parem com essas estultícies em relação à saúde e à segurança pública.

Veja, então o exemplo americano que a senhora tanto gosta. Afinal, a senhora adota o "one drop rule", (que eu particularmente abomino, mas respeito sua opinião). Esse foi o mote de um post editado nesse blogue na semana passada: JAMA publica estudo mostrando a evolução da mortalidade entre brancos e negros. Há uma redução na diferença de mortalidade entre os homens devido a redução da mortalidade por aids, traumas em geral e homicídios entre o negros. Entre as mulheres por causa das doenças cardiovasculares entre as negras.

Diferença de mortalidade entre negros e brancos nos EUA

JAMA publica estudo mostrando a evolução da mortalidade por gênero e raça. Há uma redução na mortalidade entre os homens devido a redução da mortalidade por aids, traumas em geral e homicídios. Entre as mulheres por causa das doenças cardiovasculares.

Racismo e Doença Cerebrovascular: uma hipótese

O professor Eduardo Faerstein do Instituto de Medicina Social da UERJ enviou carta apresentando o racismo com hipotético fator de risco para a doença cerebrovascular. A base foi editorial de minha autoria que pode ser acessado aqui ao lado: Stroke: a neglected disease in Brazil.
Sao Paulo Med. J. vol.124 no.5 São Paulo 2006

Hypothesis: racism is a risk factor for cerebrovascular diseases Eduardo Faerstein
I very much appreciated the editorial "Stroke in Brazil: a neglected disease",1 because it emphasized not only the high mortality rates due to cerebrovascular diseases in Brazil but also the surprising paucity of epidemiological studies that have so far investigated their determinants in our population. The editorial appropriately draws attention to the relevance of the social determinants of these conditions. I would like to suggest that the possible direct and indirect effects of racial discrimination in Brazil should be an issue for empirical investigation as potential determinants of cerebrovascular diseases. In fact, racism constitutes an additional axis of social inequalities that generate disease and deaths in our country, and has been the subject of growing academic interest.2
Recently, Chor and Lima3 reported that, differently from whites, black men and women aged 40-69 years have mortality rates from cerebrovascular diseases that are higher than from ischemic heart disease. In addition, our exploratory analyses among participants in the Pro-Saúde study in Rio de Janeiro suggested that perceived lifetime racial discrimination can increase the risk of hypertension (one major risk factor for cerebrovascular diseases), through the intervention of and/or interaction with socioeconomic adversity. These circumstances may act directly through chronic psychosocial stress and/or through more proximal etiological mechanisms in the causal chain (e.g. related to obesity).4
Research on cerebrovascular diseases in Brazil should take the possible effects of racism into account at the various stages of their natural history. In multiethnic societies such as ours this may shed light both on specific societal features of ethnicity-based discrimination – a historical, ever-changing phenomenon5 – and on its potentially wide-ranging health consequences.

REFERENCES
1. Lotufo PA. Stroke in Brazil: a neglected disease. Sao Paulo Med J. 2005;123(1):3-4.
2. Faerstein E. Fórum: raça, racismo e saúde no Brasil. [Forum on race, racism, and health in Brazil]. Cad Saúde Pública. 2005;21(5):1584-5.
3. Chor D, Lima CRA. Aspectos epidemiológicos das desigualdades raciais em saúde no Brasil. [Epidemiologic aspects of racial inequalities in health in Brazil]. Cad Saúde Pública. 2005;21(5):1586-94.
4. Faerstein E, Chor D, Werneck G, Lopes CS, Lynch J, Kaplan G. Race and perceived racism, education, and hypertension among Brazilian civil servants (abstract). Am J Epidemiol. 2004;159(11):S35.
5. Fredrichson GM. Racism: a short history. New Jersey: Princeton University Press; 2003.