Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil.
Research design and methods A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death.
Results At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62).
Conclusions Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.
Research design and methods A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death.
Results At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62).
Conclusions Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.
Date Issued
2023-05-01
Date Acceptance
2023-05-29
Citation
BMJ Open Diabetes Research & Care, 2023, 11 (3)
ISSN
2052-4897
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open Diabetes Research & Care
Volume
11
Issue
3
Copyright Statement
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37349106
PII: 11/3/e003224
Subjects
CARE
DEATH
Endocrinology & Metabolism
Epidemiology
HEALTH
Life Sciences & Biomedicine
MELLITUS
Mortality
Observational Study
Public Health
Science & Technology
SURVIVAL
Publication Status
Published
Coverage Spatial
England
Article Number
e003224
Date Publish Online
2023-06-22