HEP 444 Module 7 Epidemiology Data Analysis

Association between Demographic, Lifestyle, and Physical Characteristics on Diabetes Risk.

10/02/2022

EXW 444

Introduction

This study investigates the association between diabetes and several identified factors. Epidemiology, as we’ve learned so far, is the study of the causes and patterns of illness and other health-related occurrences. The foundation of this research is that disease occurrences are not coincidental but rather follow predictable patterns. Finding and documenting these trends is thus an important element of epidemiological work. Among the studied risk factors include gender, age, tobacco use, hypertension awareness, BMI category, and level of physical activity. Nearly 17% of the 65-74-year-old population in the United States had diabetes in 2004, according to the Centers for Disease Control and Prevention (CDC), with a somewhat lower incidence among those 75 and older. Diabetic incidence is greater among obese males (11.46%) than obese women (9.19%) (Sujata Thakur, 2021).

Smoking, being overweight, physical inactivity, and hypertension are risk factors for contracting diabetes. According to a CDC report, 19.8% of diabetic individuals were tobacco users (CDC, 2020). The same report also highlighted that 89.8% of diabetic individuals were overweight, i.e., they had a BMI greater than 25.0 kg/m2. In addition, the report showed that among the diabetic individuals, 34.3% were not physically active, i.e., they had less than 15 minutes a week of vigorous or moderate physical activity (CDC, 2020). Lastly, the report identified that 69% of diabetic individuals had systolic blood pressure higher than 140mmHg.

The purpose of this study was to examine the association between 6 risk factors and diabetes. The risk factors included age, sex, level of physical activity, smoking, high blood pressure, and BMI. The data used in this study were sourced from the 2017 (BRFSS) Behavioral Risk Factor Surveillance System Survey. The 95% confidence intervals and odd ratios were computed to aid in determining the associations between the risk factors and outcomes.

Methods and Results

The data used in this study were sourced from the 2017 BRFSS (Behavioral Risk Factor Surveillance System Survey). The data from this survey enabled one to construct a 2 x 2 epidemiology study table. The tables constructed have been attached at the end of this paper. After carefully cross-checking the tables, the data in the table was filled in the openepi.com website that generated the odd ratios and the 95% confidence intervals for each variable. The odd ratios were also manually calculated and cross-checked with the generated values. There were minimal disparities between the calculated and generated odd ratios.

The data is well organized in the table below. The table has 3 columns. The first column is the exposure section, where the different variables are noted. The second column is the Sample size, where the sample size for each variable has been noted down. The third column consists of the odds ratios and the 95% confidence intervals for each variable.

The demographic risk factors that were analyzed were age and gender. Between these factors, age had the highest odds ratio i.e., an odds ratio of 3.335 and 95% CI of 2.96 and 3.757, 14.35 and 95% CI of 12.79 and 16.11, and 23.35 and a 95% CI of 20.72 and 26.09 for age brackets 25-44, 44-64, and 65+, respectively. Gender had a very low odds ratio (1.062 and 95% CI of 1.044 and 1.08). The lifestyle risk factors that were analyzed were smoking (odds ratio of 0.8998 and CI of 0.8773 and 0.923) and the level of physical activity in one’s life (odds ratio of 0.5524 for 1-149 minutes of activity and odds ratio of 0.4851 for 150+ minutes of activity per week). The physical characteristic risk factors that were analyzed were body weight and hypertension. Being overweight had an odds ratio of 2.066(CI of 2.01-2.124), and being obese had an odds ratio of 4.689 (CI of 4.568 – 4.813). Hypertension status had an odds ratio of 5.421. 

Risk factors for type 2 Diabetes: 2005 BRFSS

Exposure

Sample

N (%)

Odds Ratio

(95% CI)

Gender

448,943

   Female

1.0

   Male

1.062

(95% CI, 1.044, 1.08)

Age Group (years)

449,219

   18-24

1.0

   25-44

3.335

(95% CI, 2.96, 3.757)

   44-64

14.34

(95% CI, 12.79, 16.11)

    65+

23.25

(95% CI, 20.72, 26.09)

Body Mass Index  

413,007

   Normal 

1.0

   Overweight

2.066

(95% CI, 2.01, 2.124)

   Obese

4.689

(95% CI, 4.568, 4.813)

Hypertension Status

447,940

   No

1.0

   Yes

 5.421

(95% CI, 5.317, 5.528)

Smoking Status

430,594

   Former or Never 

1.0

   Current

0.8998

(95% CI, 0.8773, 0.923)

Physical Activity Level

399,287

   None

1.0

   1-149 minutes per week

0.5524

(95% CI, 0.5379, 0.5673)

   150+ minutes per week

0.4851

(95% CI, 0.4755, 0.4949)

Discussion

The purpose of this study was to investigate the relationship between some risk factors and diabetes incidence. Potential risk factors with the highest risk of diabetes were age, hypertension status, and BMI category. The age risk factor depicted a dose-response relationship whereby the odds ratio increased as the age increased. The 65+ age bracket had an odds ratio of 23.25, the 44-64 age bracket had an odds ratio of 14.34, and the 18-24 age bracket had an odds ratio of 3.335. The BMI category also depicted a dose-response relationship. The odds ratio was not significant for the gender risk factor.

Fletcher et al., 2002 identified several risk factors for type 2 Diabetes mellitus in their study. The risk factors included family history, age, race/ethnicity, Gestational Diabetes Mellitus, Insulin resistance, Impaired Glucose Resistance, obesity, and physical inactivity. Among these factors, this investigation researched age, obesity, and physical inactivity factors. All these factors were found to have an association with diabetes in both the Fletcher article and this study.

There are several intervention measures that one can take to prevent diabetes. By controlling one’s weight, increasing physical activity, consuming a balanced diet, and refraining from smoking, diabetes can be avoided in most cases (Kenney, 2022). However, altering one’s habits requires a collaborative effort. Making healthy choices is the way to go.

In general, all of these risk factors were found to have an association with the risk of contracting diabetes. The less than 1 value in the smoking status categories shows that most individuals probably quit smoking after being diagnosed with diabetes. The results showed that more former smokers had diabetes than current smokers. As aforementioned, diabetes is preventable and needs a collaborative effort from all stakeholders in managing it.

References

CDC. (2020). Risk Factors for Diabetes-Related Complications. Retrieved October 2, 2022, from www.cdc.gov: https://www.cdc.gov/diabetes/data/statistics-report/risks-complications.html

Fletcher, B., Gulanick, M., & Lamendola, C. (2002). Risk factors for type 2 diabetes mellitus. Journal of Cardiovascular Nursing, 16(2), 17-23.

Kenney, E. (2022). The Nutrition Source. Retrieved October 2, 2022, from www.hsph.harvard.edu/: https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention

Sujata Thakur, R. T. (2021, November 22). Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis. Retrieved October 2, 2022, from www.nature.com: https://www.nature.com/articles/

2 x 2 Tables and Odds Ratio Computation

Variable 1: Gender

Has Diabetes

Does Not Have Diabetes

Total

Males

27457

170868

198325

Females (referent)

32944

217684

250628

448953

Odds Ratio = a*d/b*c = 1.062

Variable 2: Age Group

Has Diabetes

Does Not Have Diabetes

Total

25-44 years

3640

95526

99166

18-24 yrs. (referent)

296

25906

26202

125368

Odds Ratio = a*d/b*c = 3.335

Has Diabetes

Does Not Have Diabetes

Total

45-64 years

23406

142746

166152

18-24 yrs. (referent)

296

25906

26202

192354

Odds Ratio = a*d/b*c = 14.351

Has Diabetes

Does Not Have Diabetes

Total

65+ years

33098

124601

157699

18-24 yrs (refferent)

296

25906

26202

183901

Odds Ratio = a*d/b*c = 23.248

Variable 3: Body Mass Index Category

Has Diabetes

Does Not Have Diabetes

Total

Overweight

17684

131279

148963

Normal weight

7878

120832

128710

277673

Odds Ratio = a*d/b*c = 2.066

Has Diabetes

Does Not Have Diabetes

Total

Obese

30068

98359

128427

Normal weight

7878

120832

128710

257137

Odds Ratio = a*d/b*c = 4.689

Variable 4: Hypertension Awareness

Has Diabetes

Does Not Have Diabetes

Total

told they have hypertension

44901

135833

180734

told they don’t have hypertension

15357

251849

267206

447940

Odds Ratio = a*d/b*c = 5.421

Variable 5: Tobacco Use

Has Diabetes

Does Not Have Diabetes

Total

Current smoker

7899

55423

63322

Former smoker

50217

317055

367272

430594

Odds Ratio = a*d/b*c = 0.900

Variable 6: Physical Activity Level (PA)

Has Diabetes

Does Not Have Diabetes

Total

1-149 minutes per week

8701

64540

73241

0 minutes per week

23586

96643

120229

193470

Odds Ratio = a*d/b*c = 0.552

Has Diabetes

Does Not Have Diabetes

Total

150+ minutes per week

21788

184029

205817

0 minutes per week

23586

96643

120229

326046

Odds Ratio = a*d/b*c = 0.485