{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T11:24:09Z","timestamp":1764588249993,"version":"3.37.3"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Endocrinol Invest"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Ethnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>During follow-up (median 9.8\u00a0years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90\u201320.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07\u20132.32)) and 30% higher in Blacks (HR 1.34 (1.23\u20131.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73\u201324.92) and 4.78 (4.51\u20135.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55\u20130.90)) and Blacks (HR 0.71 (0.51\u20130.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions\/Interpretation<\/jats:title>\n                <jats:p>Type 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-021-01736-9","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T16:02:44Z","timestamp":1642089764000},"page":"1011-1020","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9720-1180","authenticated-orcid":false,"given":"B.","family":"Iyen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Vinogradova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. K.","family":"Akyea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Weng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Qureshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Kai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"1736_CR1","volume-title":"Global report on diabetes","author":"World Health Organization","year":"2016","unstructured":"World Health Organization (2016) Global report on diabetes. Switzerland, Geneva"},{"key":"1736_CR2","volume-title":"Global status report on noncommunicable diseases","author":"World Health Organization","year":"2014","unstructured":"World Health Organization (2014) Global status report on noncommunicable diseases. World Health Organization, Geneva"},{"issue":"7","key":"1736_CR3","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.2337\/dc06-0057","volume":"29","author":"I Shai","year":"2006","unstructured":"Shai I, Jiang R, Manson JE, Stampfer MJ, Willett WC, Colditz GA et al (2006) Ethnicity, obesity, and risk of type 2 diabetes in women. Diabetes Care 29(7):1585","journal-title":"Diabetes Care"},{"issue":"2","key":"1736_CR4","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1111\/dme.12576","volume":"32","author":"T Tillin","year":"2015","unstructured":"Tillin T, Sattar N, Godsland IF, Hughes AD, Chaturvedi N, Forouhi NG (2015) Ethnicity-specific obesity cut-points in the development of type 2 diabetes\u2014a prospective study including three ethnic groups in the United Kingdom. Diabet Med 32(2):226\u2013234","journal-title":"Diabet Med"},{"issue":"4","key":"1736_CR5","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1177\/1474651413495703","volume":"13","author":"C Nwaneri","year":"2013","unstructured":"Nwaneri C, Cooper H, Bowen-Jones D (2013) Mortality in type 2 diabetes mellitus: magnitude of the evidence from a systematic review and meta-analysis. Br J Diabetes Vasc Dis 13(4):192\u2013207","journal-title":"Br J Diabetes Vasc Dis"},{"issue":"8","key":"1736_CR6","doi-asserted-by":"publisher","first-page":"2366","DOI":"10.2337\/dc12-1513","volume":"36","author":"KS Taylor","year":"2013","unstructured":"Taylor KS, Heneghan CJ, Farmer AJ, Fuller AM, Adler AI, Aronson JK et al (2013) All-cause and cardiovascular mortality in middle-aged people with type 2 diabetes compared with people without diabetes in a large UK primary care database. Diabetes Care 36(8):2366","journal-title":"Diabetes Care"},{"issue":"3","key":"1736_CR7","doi-asserted-by":"publisher","first-page":"338","DOI":"10.2337\/dc16-1616","volume":"40","author":"AK Wright","year":"2017","unstructured":"Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK et al (2017) Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care 40(3):338\u2013345","journal-title":"Diabetes Care"},{"issue":"2","key":"1736_CR8","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1136\/jech.50.2.137","volume":"50","author":"N Chaturvedi","year":"1996","unstructured":"Chaturvedi N, Fuller JH (1996) Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health 50(2):137","journal-title":"J Epidemiol Community Health"},{"issue":"10","key":"1736_CR9","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s11892-017-0929-5","volume":"17","author":"E Johns","year":"2017","unstructured":"Johns E, Sattar N (2017) Cardiovascular and mortality risks in migrant South Asians with type 2 diabetes: are we winning the battle? Curr Diab Rep 17(10):100","journal-title":"Curr Diab Rep"},{"key":"1736_CR10","unstructured":"Welcome to Clinical Practice Research Datalink (2020) https:\/\/www.cprd.com\/home\/"},{"issue":"3","key":"1736_CR11","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1093\/ije\/dyv098","volume":"44","author":"E Herrett","year":"2015","unstructured":"Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T et al (2015) Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol 44(3):827\u2013836","journal-title":"Int J Epidemiol"},{"key":"1736_CR12","unstructured":"Office for National Statistics (2018) Population of England and Wales by ethnicity. https:\/\/www.ethnicity-facts-figures.service.gov.uk\/uk-population-by-ethnicity\/national-and-regionalpopulations\/population-of-england-and-wales\/latest"},{"key":"1736_CR13","unstructured":"The English Index of Multiple Deprivation (IMD) (2015) In: Department for housing, communities and local government, editor. London 2015. https:\/\/www.gov.uk\/government\/statistics\/english-indices-ofdeprivation-2015"},{"issue":"7659","key":"1736_CR14","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1136\/bmj.39609.449676.25","volume":"336","author":"J Hippisley-Cox","year":"2008","unstructured":"Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A et al (2008) Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 336(7659):1475\u20131482","journal-title":"BMJ"},{"key":"1736_CR15","doi-asserted-by":"publisher","first-page":"95","DOI":"10.4137\/BMI.S38440","volume":"11","author":"SI Sherwani","year":"2016","unstructured":"Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK (2016) Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights 11:95\u2013104","journal-title":"Biomark Insights"},{"key":"1736_CR16","unstructured":"Weir CB, Jan A (2021) BMI Classification percentile and cut off points. In: StatPearls. StatPearls Publishing. Treasure Island (FL)"},{"key":"1736_CR17","doi-asserted-by":"publisher","first-page":"157","DOI":"10.2147\/CLEP.S129785","volume":"9","author":"AB Pedersen","year":"2017","unstructured":"Pedersen AB, Mikkelsen EM, Cronin-Fenton D, Kristensen NR, Pham TM, Pedersen L et al (2017) Missing data and multiple imputation in clinical epidemiological research. Clin Epidemiol 9:157\u2013166","journal-title":"Clin Epidemiol"},{"issue":"3","key":"1736_CR18","doi-asserted-by":"publisher","first-page":"e000828","DOI":"10.1161\/JAHA.114.000828","volume":"3","author":"D Thompson","year":"2014","unstructured":"Thompson D, Walhin JP, Batterham AM, Stokes KA, Cooper AR, Andrews RC (2014) Effect of diet or diet plus physical activity versus usual care on inflammatory markers in patients with newly diagnosed type 2 diabetes: the Early ACTivity in Diabetes (ACTID) randomized, controlled trial. J Am Heart Assoc 3(3):e000828","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"1736_CR19","doi-asserted-by":"publisher","first-page":"e0215362","DOI":"10.1371\/journal.pone.0215362","volume":"14","author":"J Wang","year":"2019","unstructured":"Wang J, Chen Y, Xu W, Lu N, Cao J, Yu S (2019) Effects of intensive blood pressure lowering on mortality and cardiovascular and renal outcomes in type 2 diabetic patients: a meta-analysis. PLoS ONE 14(4):e0215362","journal-title":"PLoS ONE"},{"issue":"1","key":"1736_CR20","doi-asserted-by":"publisher","first-page":"e000185","DOI":"10.1136\/bmjdrc-2015-000185","volume":"4","author":"JJ Joseph","year":"2016","unstructured":"Joseph JJ, Echouffo-Tcheugui JB, Golden SH, Chen H, Jenny NS, Carnethon MR et al (2016) Physical activity, sedentary behaviors and the incidence of type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis (MESA). BMJ Open Diabetes Res Care 4(1):e000185","journal-title":"BMJ Open Diabetes Res Care"},{"key":"1736_CR21","doi-asserted-by":"publisher","first-page":"7014857","DOI":"10.1155\/2016\/7014857","volume":"2016","author":"M Wang","year":"2016","unstructured":"Wang M, Yi Y, Roebothan B, Colbourne J, Maddalena V, Wang PP et al (2016) Body mass index trajectories among middle-aged and elderly Canadians and associated health outcomes. J Environ Public Health 2016:7014857","journal-title":"J Environ Public Health"},{"issue":"10","key":"1736_CR22","doi-asserted-by":"publisher","first-page":"2107","DOI":"10.1038\/oby.2012.29","volume":"20","author":"ES Wong","year":"2012","unstructured":"Wong ES, Wang BC, Alfonso-Cristancho R, Flum DR, Sullivan SD, Garrison LP et al (2012) BMI trajectories among the severely obese: results from an electronic medical record population. Obesity (Silver Spring) 20(10):2107\u20132112","journal-title":"Obesity (Silver Spring)"},{"issue":"1","key":"1736_CR23","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1186\/s12889-021-10606-1","volume":"21","author":"B Iyen","year":"2021","unstructured":"Iyen B, Weng S, Vinogradova Y, Akyea RK, Qureshi N, Kai J (2021) Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK. BMC Public Health 21(1):576","journal-title":"BMC Public Health"},{"issue":"1","key":"1736_CR24","doi-asserted-by":"publisher","first-page":"96","DOI":"10.2337\/dc10-0865","volume":"34","author":"NA Khan","year":"2011","unstructured":"Khan NA, Wang H, Anand S, Jin Y, Campbell NR, Pilote L et al (2011) Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care 34(1):96\u2013101","journal-title":"Diabetes Care"},{"issue":"5","key":"1736_CR25","doi-asserted-by":"publisher","first-page":"e1002741","DOI":"10.1371\/journal.pgen.1002741","volume":"8","author":"JR Perry","year":"2012","unstructured":"Perry JR, Voight BF, Yengo L, Amin N, Dupuis J, Ganser M et al (2012) Stratifying type 2 diabetes cases by BMI identifies genetic risk variants in LAMA1 and enrichment for risk variants in lean compared to obese cases. PLoS Genet 8(5):e1002741","journal-title":"PLoS Genet"},{"issue":"7","key":"1736_CR26","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1093\/oxfordjournals.aje.a116731","volume":"137","author":"JA Marshall","year":"1993","unstructured":"Marshall JA, Hamman RF, Baxter J, Mayer EJ, Fulton DL, Orleans M et al (1993) Ethnic differences in risk factors associated with the prevalence of non-insulin-dependent diabetes mellitus: the San Luis valley diabetes study. Am J Epidemiol 137(7):706\u2013718","journal-title":"Am J Epidemiol"},{"issue":"5","key":"1736_CR27","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/j.1464-5491.1992.tb01812.x","volume":"9","author":"D Simmons","year":"1992","unstructured":"Simmons D, Williams DRR, Powell MJ (1992) Prevalence of diabetes in different regional and religious South Asian communities in Coventry. Diabet Med 9(5):428\u2013431","journal-title":"Diabet Med"},{"issue":"958","key":"1736_CR28","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1136\/pgmj.2004.029124","volume":"81","author":"J Oldroyd","year":"2005","unstructured":"Oldroyd J, Banerjee M, Heald A, Cruickshank K (2005) Diabetes and ethnic minorities. Postgrad Med J 81(958):486","journal-title":"Postgrad Med J"},{"issue":"9","key":"1736_CR29","doi-asserted-by":"publisher","first-page":"2670","DOI":"10.2337\/dc12-2105","volume":"36","author":"BR Shah","year":"2013","unstructured":"Shah BR, Victor JC, Chiu M, Tu JV, Anand SS, Austin PC et al (2013) Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients. Diabetes Care 36(9):2670","journal-title":"Diabetes Care"},{"issue":"23","key":"1736_CR30","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","volume":"363","author":"A Berrington-de-Gonzalez","year":"2010","unstructured":"Berrington-de-Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ et al (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363(23):2211\u20132219","journal-title":"N Engl J Med"},{"issue":"15","key":"1736_CR31","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1056\/NEJM199910073411501","volume":"341","author":"EE Calle","year":"1999","unstructured":"Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW (1999) Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 341(15):1097\u20131105","journal-title":"N Engl J Med"},{"issue":"4","key":"1736_CR32","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1017\/S1368980008002802","volume":"12","author":"CP Wen","year":"2009","unstructured":"Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC et al (2009) Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr 12(4):497\u2013506","journal-title":"Public Health Nutr"},{"key":"1736_CR33","doi-asserted-by":"crossref","unstructured":"WHO Expert (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403):157\u2013163","DOI":"10.1016\/S0140-6736(03)15268-3"}],"container-title":["Journal of Endocrinological Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-021-01736-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40618-021-01736-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-021-01736-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,10]],"date-time":"2022-04-10T09:22:19Z","timestamp":1649582539000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40618-021-01736-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,13]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["1736"],"URL":"https:\/\/doi.org\/10.1007\/s40618-021-01736-9","relation":{},"ISSN":["1720-8386"],"issn-type":[{"type":"electronic","value":"1720-8386"}],"subject":[],"published":{"date-parts":[[2022,1,13]]},"assertion":[{"value":"6 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"Data access and ethical approval for the study was granted by the CPRD Independent Scientific Advisory Committee (Protocol number 18_195A).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"This research did not involve human participants and\/or animals, and so informed consent for this is not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}