SEARCHCOHORTendocrinology, epidemiology

cohort·endocrinology, epidemiology, public health, internal medicine, family medicine·PMC10314413

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

BMJ Open Diabetes Research & Care · 19 authors, 11 centres

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TL;DR

The study was limited by its observational design using administrative records, potential residual confounding, absence of data on housing or neighbourhood conditions, and the inability to establish causation.

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cohort

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endocrinology

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ORIGINAL PAPER

PMC10314413

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

BMJ Open Diabetes Research & Care

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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.

CITATION EXPORT

Renzo Flores-Ortiz, Rosemeire L Fiaccone, Alastair Leyland et al.. Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil. BMJ Open Diabetes Research & Care. (2023). https://doi.org/10.1136/bmjdrc-2022-003224

AUTHORS

19 · 11 CENTRES

Renzo Flores-Ortiz, Rosemeire L Fiaccone, Alastair Leyland, Christopher Millett, Thomas Hone, Maria Inês Schmidt, Andrêa J F Ferreira, Maria Y Ichihara, Camila Teixeira, Mauro N Sanchez, Julia Pescarini, Estela M L Aquino, Deborah C Malta, Gustavo Velasquez-Melendez, Juliane Fonseca de Oliveira, Peter Craig, Rita C Ribeiro-Silva, Mauricio L Barreto, Srinivasa Vittal Katikireddi

1 Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
2 Institute of Mathematics, Federal University of Bahia, Salvador, Brazil
3 University of Glasgow, Glasgow, UK
4 Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
5 Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
6 Tropical Medicine Center, University of Brasilia, Brasília, Brazil
7 Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
8 Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
9 Center of Mathematics of University of Porto (CMUP), University of Porto, Porto, Portugal
10 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
11 School of Nutrition, Federal University of Bahia, Salvador, Brazil