Country characteristics and variation in diabetes prevalence among Asian countries - an ecological study / Journal of the ASEAN Federation of Endocrine Societies

@#<p> OBJECTIVE:</b> To determine the variation in diabetes prevalence across Asian countries and its relationship with the quality of health system and socioeconomic characteristics of the country.</p><p><strong>METHODOLOGY:</strong> An ecological analysis was conducted using publicly available data from the World Bank, the World Health Organization and the International Diabetes Federation. Geographical variation in diabetes prevalence across countries was examined using control charts while the relationships between country-level determinants and diabetes prevalence were investigated using linear regression analysis.</p><p><strong>RESULTS:</strong> The control chart shows special-cause variation in diabetes prevalence in 21 (58%) of the Asian countries; nine countries were below the 99.8% control limits while twelve were above it.</p><p>Fifteen (42%) countries suggest common-cause variation. Three country characteristics independently associated with diabetes prevalence were hypertension prevalence (OR 0.39, 95% CI 0.22 to 0.55; p-value<0.001), obesity prevalence (OR 0.15, 95% CI 0.13 to 0.18; p-value<0.001), and quality of health care governance (OR 0.18, 95% CI 0.04 to 0.34; p-value=0.02).</p><p><strong>CONCLUSION:</strong> There is a considerable geographical variation in diabetes prevalence across Asian countries. A substantial part of this variation could be explained by differences in the quality of health care governance, hypertension prevalence and obesity prevalence.</p>

Electrocardiogram abnormalities and coronary calcification in postmenopausal women

An electrocardiogram [ECG] can provide information on subclinical myocardial damage. The presence, and more importantly the quantity of coronary artery calcification [CAC], relates well with the overall severity of the atherosclerotic process. A strong relation has been demonstrated between coronary calcium burden and the incidence of myocardial infarction, a relation independent of age. The aim of this study was to assess the relation of left ventricular hypertrophy [LVH] and ECG abnormalities with CAC. The study population comprised 566 postmenopausal women selected from a population-hated cohort study. Information on LVH and repolarization abnormalities [T-axis and QRS-T angle] was obtained using electrocardiography Modular ECG Analysis System [MEANS] was used to assess ECG abnormalities. The women underwent a multi detector-row computed tomography [MDCT] scan [Philips Mx 8000 IDT 16] to assess CAC. The Agatston score was used to quantify CAC; scores greater than zero were considered as the presence of coronary calcium. Logistic regression was used to assess the relation of ECG abnormality with coronary calcification. LVH was found in 2.7% [n = 15] of the women. The prevalence of T-axis abnormality was 6% [n = 34], whereas 8.5% [n = 48] had a QRS-T angle abnormality. CAC was found in 62% of the women. Compared to women with a normal T-axis, women with borderline or abnormal T-axes were 3.8 fold more likely to have CAC [95% CI: 1.4-10.2]. Similarly compared to women with a normal QRS-T angle, in women with borderline or abnormal QRS-T angle, CAC was 2.0 fold more likely to be present [95% CI: 1.0-4.1]. Among women with ECG abnormalities reflecting subclinical ischemia, CAC is commonly found and may in part explain the increased coronary heart disease risk associated with these ECG abnormalities