Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK,Diabetologia

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Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK
Diabetologia ( IF 8.4 ) Pub Date : 2021-10-20 , DOI: 10.1007/s00125-021-05580-7
Aliki-Eleni Farmaki ₁ , Victoria Garfield ₁ , Sophie V Eastwood ₁ , Ruth E Farmer ₂ , Rohini Mathur ₂ , Olga Giannakopoulou _{3,

4} , Praveetha Patalay _{1,

5} , Karoline Kuchenbaecker _{3,

4} , Naveed Sattar ₆ , Alun Hughes ₁ , Krishnan Bhaskaran ₂ , Liam Smeeth ₂ , Nish Chaturvedi ₁

Affiliation

Aims/hypothesis

Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity.

Methods

Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40–69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA_1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively.

Results

Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis.

Conclusions/interpretation

Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk.

Graphical abstract

中文翻译：

英国第二代移民以及南亚和非洲加勒比裔混血人群的 2 型糖尿病风险和决定因素

目标/假设

与欧洲人相比，英国南亚人 (SA) 和非洲加勒比人 (AC) 患 2 型糖尿病的风险过高仍然无法解释。我们研究了第一代和第二代（在英国出生）移民以及混血移民患 2 型糖尿病的风险和决定因素。

方法

使用的数据来自英国生物银行，这是一个基于人口的队列，招募时有约 500,000 名年龄在 40-69 岁之间的参与者。使用自我报告和 HbA _1c来分配 2 型糖尿病。种族既是自我报告的，也是使用混合水平分数进行基因分配的。对欧洲、欧洲/南亚混合 (MixESA)、欧洲/非洲加勒比混合 (MixEAC)、SA 和 AC 组进行了分析，匹配年龄和性别以进行比较。在这项横断面研究的框架中，我们比较了第二代移民与第一代移民、混合种族与非混合种族的 2 型糖尿病。分别使用逻辑回归和中介分析来分析风险和解释。

结果

与欧洲人 (140/3324 = 4%) 相比，南澳 (599/3317 = 18%) 和AC (534/4180 = 13%) 2 型糖尿病患病率显着升高。第二代SA（124/1115 = 11% vs 155/1115 = 14%）和AC（163/2200 = 7% vs 227/2200 = 10%）的患病率较低。良好的肥胖水平（即较低的腰臀比或BMI）有助于降低第二代移民的风险。混合人群中的 2 型糖尿病（MixESA：52/831 = 6%，MixEAC：70/1045 = 7%）低于对照种族群体（SA：18%，AC：13%），高于欧洲人（4 %）。与欧洲人相比，MixESA 和 MixEAC 人群的 2 型糖尿病超额风险中，更大的社会经济剥夺分别占 17% 和 42%。用基因分配的种族取代自我报告证实了混合种族分析。