Farmaki, A-E;
Garfield, V;
Eastwood, S;
Farmer, R;
Mathur, R;
Patalay, P;
Sattar, N;
... Chaturvedi, N; + view all
(2020)
Type 2 diabetes risks and determinants in 2nd generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK.
MedRxiv: Cold Spring Harbor, NY, USA.
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2019.12.13.19014704v1.full.pdf - Accepted Version Download (1MB) | Preview |
Abstract
Objectives: Excess risks of type 2 diabetes mellitus (T2DM) in UK South Asians (SA) and African Caribbeans (AC) compared to Europeans remain unexplained. We studied risks and determinants of T2DM in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. / Design: Cross sectional analysis comparing T2DM in 2nd versus 1st generation migrants, and mixed ethnicity with non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. / Setting: UK Biobank, a population-based cohort of ~500k participants aged 40-69 at recruitment. / Participants: Ethnicity was both self-reported and genetically-assigned using admixture level scores. Europeans, mixed European/South Asians (MixESA), mixed European/African Caribbeans (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. / Main outcome measures: T2DM using self-report and glycated haemoglobin. / Results: T2DM prevalence was three to five times higher in SA and AC compared with Europeans [OR (95%CI): 4.80(3.60,6.40) and 3.30(2.70,4.10), respectively]. T2DM was 20-30% lower in second-versus first-generation SA and AC [0.78(0.60,1.01) and 0.71(0.57,0.87), respectively]. Favourable adiposity contributed to lower risk in 2nd generation migrants. T2DM in mixed populations was lower than comparator ethnic groups [MixESA versus SA 0.29(0.21,0.39), MixEAC versus AC 0.48(0.37,0.62)] and higher than Europeans, in MixESA 1.55(1.11, 2.17), and in MixEAC 2.06 (1.53, 2.78). Greater socioeconomic deprivation accounted for 17% and 42% of the excess T2DM risk in MixESA and MixEAC compared to Europeans, respectively. Replacing self-reported with genetically-assigned ethnicity corroborated the mixed population analysis. / Conclusions: T2DM risks in 2nd generation SA and AC migrants are a fifth lower than 1st generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, play a key role in accounting for ethnic differences in T2DM risk.
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