Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil

Flores-Ortiz, R. et al. (2023) Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil. BMJ Open Diabetes Research and Care, 11(3), e003224. (doi: 10.1136/bmjdrc-2022-003224) (PMID:37349106) (PMCID:PMC10314413)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Craig, Professor Peter and Leyland, Professor Alastair
Authors: Flores-Ortiz, R., Fiaccone, R. L., Leyland, A. H., Millett, C., Hone, T., Schmidt, M. I., Ferreira, A. J.F., Ichihara, M. Y., Teixeira, C., Sanchez, M., Pescarini, J., Aquino, E. M.L., Malta, D. C., Velasquez-Melendez, G., Oliveira, J. F. d., Craig, P., Ribeiro-Silva, R. C., Barreto, M. L., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:BMJ Open Diabetes Research and Care
Publisher:BMJ Publishing Group
ISSN:2052-4897
ISSN (Online):2052-4897
Published Online:22 June 2023
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2023
First Published:First published in BMJ Open Diabetes Research and Care 11(3):e003224
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
300390Strengthening data linkage to reduce health inequalities in low and middle income countries: building on the Brazilian 100 million cohortAlastair LeylandNational Institute for Health Research (NIHR)16/137/99SHW - MRC/CSO Social & Public Health Sciences Unit
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02SHW - Public Health