Exposure-Disease Paradigm in Regards to Type II Diabetes

Exposure-Disease Paradigm in Regards to Type II Diabetes

Tanya Staton

MPH 584

Dr. Wheeler

7/07/2014

Exposure-Disease Paradigm in Regards to Type II Diabetes

Diabetes is a disease that affects 23.6 million Americans, and is responsible for billions of dollars in healthcare costs annually(Egede, Mueller, Echols, & Gebregziabher, 2010). It is estimated that globally 439 million people could have diabetes by 2030 due to population ageing, urbanization and associated lifestyle changes (Chen, MaglianoZimmet, 2012). African Americans, Mexican Americans, American Indians, Native Hawaiians, Pacific Islanders and Asian Americans are therace/ethnic groups most likely to develop type 2 diabetes (diabetes.org, 2014). Predispositioncannot be the only cause for these individuals to have an increase rate of diabetes. There must be other underlying health disparitiesoccurring.

Gilbert Gee and Devon Payne-Sturges (2004) journal article, “Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts” utilizes a model known as the exposure-disease paradigm. This model takes into account that race/ethnicity and residential segregation play a role in community-level vulnerability which then can develop into individual-level vulnerability (Gee & Payne-Sturges, 2004). Although, segregation has been on the decline since the 1980’s it is still present and has been linked to race and environmental health disparities (Gee & Payne-Sturges, 2004). Environmental hazards, structural factors, community stressors and neighborhood resources are also linked between race and residential location (Gee & Payne-Sturges, 2004). The exposure-disease paradigm is a model that can be represented in many cases. Discussed below are three journal articles on type 2 diabetes and how they compare to the exposure-disease paradigm.

The journal article “Longitudinal Differences in Glycemic Control by Race/Ethnicity Among Veterans with Type 2 Diabetes”correlates with the exposure-disease paradigm presented by Gee and Payne-Sturges through structural factors. The researchers hypothesized that non-Hispanic Blackveterans would have less control over theirhemoglobin A1c (HbA1c) levels over time compared to non-Hispanic Whites (Egede et al., 2010). Non-Hispanic Blacks had an increase HbA1c baseline level to begin with compared to whites, but over the course of the studyboth groups had similar patterns of change (Egede et al., 2010). Thus, it appears that race/ethnicity does not play a role. However, after adjusting for age, gender, employment, marital status and comorbidities non-Hispanic Blacks HbA1c levels were higher than non-Hispanic Whites (Egede et al, 2010). Their environment fosters if they had poor glucose control. Although, not always the case social class can be an important facilitator in one’s health (Egede et al, 2010). An increase in an individual’s economic infrastructure is proportional to their health status.

The journal article “Regional, Geographic, and Racial/Ethnic Variation in Glycemic Control in a National Sample of Veterans with Diabetes” examines how race/ethnicity and residential location can lead to health disparities among groups.The study concluded that HbA1c levels were higher in rural areas compared to urban areas (Egede et al., 2011).This research studyactually did not compare with the exposure-disease paradigm. According to Gee and Payne-Sturges(2004), urban minorities tend to fare worse than their counterparts in rural areas due to land pattern use (pg. 1648). The increase in HbA1c levels in rural areas may be in part to fewer pharmacies, physicians or hospitals. A lack of available resources would be consistent with structural barriers that increase health disparities.

The final journal article, “An Environment-Wide Association Study (EWAS) on Type 2 Diabetes Mellitus” explores how environmental hazards and pollutants can affect disadvantaged communities leading to an increase risk of diabetes. The researchers identified 266 unique environmental factors thought to be associated with type 2 diabetes (Patel,Bhattacharya & Butte, 2010). Diabetic participants enrolled in the study had their blood drawn and tested for multiple chemicals and pollutants. The participants also provided data by answering surveys. The researchers rediscovered that carotenes and PCBs were associated with increased risks for type 2 diabetes independent of dietary intake (Patel et al., 2010). They also discovered that γ-tocopherol was an additional chemical associated with an increase probability of getting type 2 diabetes (Patel et al., 2010). As with the previously reviewed journal articles there was also a significant association between socioeconomic status and type 2 diabetes.

Models like the exposure-disease paradigm have been developed to help us easily recognize that health disparities still exist. I agree with Gee and Payne-Sturges (2004) that to eliminate health disparities in the environment we need to focus our attention on environmental hazards and social conditions. Chronic conditions like type 2 diabetes will always be prevalent. Therefore, it is time we focus on prevention strategies to address structural factors and community stressors that are affecting everyone’s health, not just the majority.

References:

American Diabetes Association. (2014). Age, Race, Gender and family History. Retrieved from

Chen L, Magliano DJ, Zimmet PZ. (2011).The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives.National Review Endocrinology, 8;8(4): 228-36. doi: 10.1038/nrendo.2011.183.

Chirag, P.,Bhattacharya, J.,Butte, A. (2010). An Environment-Wide Association Study (EWAS) on Type 2 Diabetes Mellitus. Retrieved from

Egede LE, Mueller M, Echols CL, Gebregziabher M. (2010).Longitudinal differences in glycemic control by race/ethnicity among veterans with type 2 diabetes. Medical Care. 48(6): 527-33. doi: 10.1097/MLR.0b013e3181d558dc.

Egede LE, Gebregziabher M, Hunt KJ, Axon RN, Echols C, Gilbert GE, Mauldin PD. (2011).Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes.Diabetes Care,34(4):938-43. doi: 10.2337/dc10-1504.

Gee GC, Payne-Sturges DC (2004).Environmental health disparities: a framework integrating psychosocial and environmental concepts.Environmental Health Perspectives112(17):1645-53.