-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE
To describe the association of BMI with mortality in patients diagnosed with type 2 diabetes.RESEARCH DESIGN AND METHODS
Using records of 106,640 patients in Scotland, we investigated the association between BMI recorded around the diagnosis of type 2 diabetes mellitus (T2DM) and mortality using Cox proportional hazards regression adjusted for age and smoking status, with BMI 25 to <30 kg/m(2) as a referent group. Deaths within 2 years of BMI determination were excluded. Mean follow-up to death or the end of 2007 was 4.7 years.RESULTSA total of 9,631 deaths occurred between 2001 and 2007. Compared with reference group, mortality risk was higher in patients with BMI 20 to <25 kg/m(2) (-HR 1.22 [95% CI 1.13-1.32] in men, 1.32 [1.22-1.44] in women) and patients with BMI ≥35 kg/m(2) (for example, 1.70 [1.24-2.34] in men and 1.81 [1.46-2.24]) in women for BMI 45 to <50 kg/m(2)). Vascular mortality was higher for each 5-kg/m(2) increase in BMI >30 kg/m(2) by 24% (15-35%) in men and 23% (14-32%) in women, but was lower below this threshold. The results were similar after further adjustment for HbA(1c), year of diagnosis, lipids, blood pressure, and socioeconomic status.CONCLUSIONS
Patients categorized as normal weight or obese with T2DM within a year of diagnosis of T2DM exhibit variably higher mortality outcomes compared with the overweight group, confirming a U-shaped association of BMI with mortality. Whether weight-loss interventions reduce mortality in all T2DM patients requires study.
Diabetes care 11/2012; · 8.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The study objective was to describe the effect of socioeconomic status (SES) on mortality among people with type 2 diabetes.
We used a population-based national electronic diabetes database for 35- to 84-year-olds in Scotland for 2001-2007 linked to mortality records. SES was derived from an area-based measure with Q5 and Q1 representing the most deprived and affluent quintiles, respectively. Poisson regression was used to estimate relative risks (RRs) for mortality among people with type 2 diabetes compared with the population without diabetes stratified by age (35-64 and 65-84 years), sex, duration of diabetes (< 2 and ≥ 2 years), and SES.
Complete data were available for 210,994 eligible individuals (99.4%), and there were 33,842 deaths. Absolute mortality from all causes among people with type 2 diabetes increased with increasing age and socioeconomic deprivation and was higher for men than women. RR for mortality associated with type 2 diabetes was highest for women aged 35-64 years in Q1 with diabetes duration < 2 years at 4.83 (95% CI 3.15-7.40) and lowest for men aged 65-84 years in Q5 with diabetes duration ≥ 2 years at 1.13 (1.03-1.24).
SES modifies the association between type 2 diabetes and mortality so that RR for mortality is lower among more deprived populations. Age, sex, and duration of diabetes also interact with type 2 diabetes to influence RR of mortality. Differences in prevalence of comorbidities may explain these findings.
Diabetes care 03/2011; 34(5):1127-32. · 8.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the effect of a publicly funded domestic heating programme on self-reported health.
A prospective controlled study of 1281 households in Scotland receiving new central heating under a publicly funded initiative, and 1084 comparison households not receiving new heating. The main outcome measures were self-reported diagnosis of asthma, bronchitis, eczema, nasal allergy, heart disease, circulatory problems or high blood pressure; number of primary care encounters and hospital contacts in the past year; and SF-36 Health Survey scores.
Usable data were obtained from 61.4% of 3849 respondents originally recruited. Heating recipients reported higher scores on the SF-36 Physical Functioning scale (difference 2.51; 95% CI 0.67 to 4.37) and General Health scale (difference 2.57; 95% CI 0.90 to 4.34). They were less likely to report having received a first diagnosis of heart disease (OR 0.69; 95% CI 0.52 to 0.91) or high blood pressure (OR 0.77; 95% CI 0.61 to 0.97), but the groups did not differ significantly in use of primary care or hospital services.
Provision of central heating was associated with significant positive effects on general health and physical functioning; however, effect sizes were small. Evidence of a reduced risk of first diagnosis with heart disease or high blood pressure must be interpreted with caution, due to the self-reported nature of the outcomes, the limited time period and the failure to detect any difference in health service use.
Journal of epidemiology and community health 10/2008; 63(1):12-7. · 3.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Housing conditions are recognised as an important determinant of health. In the UK, interventions to improve domestic heating are in place with the expectation that they will improve health. As a component of evaluating such policies, this study assesses whether specific health outcomes are significantly associated with the extent and duration of domestic heating use, either directly or via a possible mediating effect of internal environmental conditions.
Baseline data from a prospective controlled study evaluating the health effects of a publicly-funded programme of heating improvements in Scotland were used to assess associations among heating use, internal conditions, and three specific health outcomes.
There were significant associations (P < 0.01) between measures of heating use and the presence of environmental problems in the home, such as mould and condensation. The presence of such problems was, in turn, found to be significantly predictive of two health outcomes derived from the SF-36 (P < 0.01) and of adult wheezing (P < 0.05). The direction of significant associations was highly consistent: greater levels of heating were associated with reduced likelihood of environmental problems, and the presence of environmental problems was linked to poorer health status. Heating use was not directly associated with the health outcomes considered.
The study findings are consistent with a conceptual model in which health may be influenced by usage patterns of domestic heating, via the mediating effect of poor internal environmental conditions. Since these findings are based on cross-sectional data, interpretation must be carried out cautiously. However, if confirmed by planned future work they have important implications for policy initiatives relating to domestic heating and fuel poverty.
The European Journal of Public Health 11/2006; 16(5):463-9. · 2.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to compare two different approaches to the measurement of quality in general practice: data derived from routine NHS data sets and results from an index derived from patient-collected data.
A secondary analysis of existing data sets and a cross-sectional survey were carried out in Lothian, Coventry, Oxfordshire and west London. The subjects comprised randomly selected and consenting practices, and a sample of patients within these practices. A National Health Service Practice Performance Index (NHSPPI) was constructed from 16 routinely available NHS performance indicators. The Consultation Quality Index (CQI) combines the Patient Enablement Instrument (PEI) with a measure of how well the patient knew the doctor, and with observed consultation length.
Scores for 12 of the 16 indicators varied significantly across the four regions. Mean practice NHSPPI score overall was 21.6 (SD 4.3), which varied significantly across regions. NHSPPI was predicted by practice list size, weighted deprivation index and proportion of other language patients in the practice, although their effects could not be separated. Overall there was no correlation between NHSPPI and CQI, although the prescribing component of the index was positively correlated to mean consultation length and negatively correlated with how well patients knew their doctors.
Good quality care as assessed by patients on completion of their consultation is independent of good quality care as assessed by best available measures of practice performance. We suggest that the CQI and the NHSPPI are at least as ready for use as other measures of performance in general practice.
Family Practice 03/2002; 19(1):77-84. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Patient Enablement Instrument (PEI) gives counterintuitive results with patients who normally speak non-English languages at home. The aim of this study was to find out more about why patients speaking languages other than English were more enabled in a shorter time than English-speaking patients. A cross-sectional consultation-based questionnaire survey was conducted of 2052 adult patients speaking languages other than English compared with 23790 English-speaking patients in four contrasting study areas in the UK Highest PEI scores in shortest consultation times were associated with South Asian language-speaking patients consulting in their own language. Multiple regression analysis showed that the language factors had an independent effect. We therefore conclude that these patients derive particular benefit from general practice consultations in their own language. Enablement may have a different meaning for patients speaking languages other than English.
British Journal of General Practice 02/2002; 52(474):36-8. · 1.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: General practitioner activity is increasingly under pressure to monitor its performance. The involvement of service users in the development and assessment of services is said to be a key feature of this process. This article reports on the acceptability among general practitioners of a patient-completed post-consultation measure of outcome (the Patient Enablement Instrument; PEI), and its use in conjunction with two further indicators of quality, namely time spent in consultation and patients reporting knowing the doctor well. The survey was conducted using focus groups and the administration of a postal questionnaire among a group of general practices that had participated and received feedback from a large quantitative study testing these measures. The focus group study provided useful insights into general practitioners' perceptions of patient assessment of their performance and their concerns surrounding the measurement of general practice activity. The general practitioners' perceptions of the measures under the study were enmeshed within these concerns overall. The PEI was seen as being generally acceptable as a measure of patient assessment of care, and the methods of data collection were acceptable for routine use in general practice. General practitioners who performed better in terms of their feedback scores generally approved more of the proposed measures. However, these general practitioners were not comfortable with the concept of assessment of the clinical interaction by patients, and were anxious to link such assessment explicitly with clinical (disease-related) outcome. Doctors who performed ‘better’ were no more likely than those who performed less well to advocate more use of patient assessment, or to believe that patient assessment of consultations is a reliable quality indicator. These concerns need to be addressed if patients' assessments of their care are to be taken seriously.
Primary Health Care Research & Development 12/2001; 3(01):29 - 41.
