Physician's Weekly's most recent poster has an infographic on rates of diabetes by state. That one is still behind the wall so I can't post it, but it's pretty similar to this one from 2007.
This is largely a map of percentage black or hispanic by state. Not entirely - West Virginia is a notable outlier there - but the dramatic coloring would be milder if we allowed for that. In fact, the dramatic coloring is itself pretty deceptive anyway. From 12th place to 45th is only a swing from 7.8% to 5.8% (more recent numbers and a slightly different definition).
I think that's ultimately unfair and even dangerous to African-Americans and Hispanics. Less so to whites, but them also. The idea that where you live (with all the hidden assumptions about culture) is a big part of the problem isn't going to help you much. I have been hearing good PSA's quite explicitly reminding AA's that they have a higher risk, but then memorable visuals like this one undo that good.
Food culture is different by region, and that is indeed a real thing being measured here. But genetics seems to play a larger role, which you would never dream if you just looked at the map.
The authors of the "The 10,000-Year Explosion" argue that resistance to alcoholism and adult-onset diabetes increase with the percentage of your ancestors who have the longest history of agriculture.
ReplyDeleteYes, I recall that, noting that my ancestors all lived near the North Sea, which was mixed in that regard. Some planters, but also herders and fishers, which have worse tendencies to alcohol disruption.
ReplyDeleteGraaaaah.
ReplyDeleteType I and Type II, or only Type II? They are completely different diseases, sharing only the result of chronic hyperglycemia when untreated or inadequately treated.
Did they even attempt to normalize their numbers for likelihood of diagnosis? Type II, unlike Type I, is usually not symptomatic early on - you catch it by screening. Which means that a population that's more likely to be screened has - like magic! - a higher reported incidence.
And yes, insulin resistance propensity is strongly heritable.
They were talking about adult-onset diabetes -- Type II -- and I don't recall any discussion of screening rates. But would we expect unusually high screening rates among Africans or Native Americans?
ReplyDeleteIn general we'd expect higher screening rates for populations that are more prone to the condition. (More precisely, populations that doctors think are more prone to it - since they're more likely to order the test if it's their perception that Group X has it more often.)
ReplyDeleteSo yeah, we very well might.
There are of course other factors such as how often these populations see a doctor, their age distribution (since Type II is a disease of aging), etc. etc. So for example, if doctors are more likely to order an A1c for black patients, but black people are less likely to have checkups, but older black people are more likely to have them...