The impact of type 2 diabetes on health related quality of life in Bangladesh: results from a matched study comparing treated cases with non-diabetic controls

Background Little is known about the association between diabetes and health related quality of life (HRQL) in lower-middle income countries. This study aimed to investigate HRQL among individuals with and without diabetes in Bangladesh. Methods The analysis is based on data of a case-control study, including 591 patients with type 2 diabetes (cases) who attended an outpatient unit of a hospital in Dhaka and 591 age -and sex-matched individuals without diabetes (controls). Information about socio-demographic characteristics, health conditions, and HRQL were assessed in a structured interview. HRQL was measured with the EuroQol (EQ) visual analogue scale (VAS) and the EQ five-dimensional (5D) descriptive system. The association between diabetes status and quality of life was examined using multiple linear and logistic regression models. Results Mean EQ-VAS score of patients with diabetes was 11.5 points lower (95 %-CI: −13.5, −9.6) compared to controls without diabetes. Patients with diabetes were more likely to report problems in all EQ-5D dimensions than controls, with the largest effect observed in the dimensions ‘self-care’ (OR = 5.9; 95 %-CI: 2.9, 11.8) and ‘mobility’ (OR = 4.5; 95 %-CI: 3.0, −6.6). In patients with diabetes, male gender, high education, and high-income were associated with higher VAS score and diabetes duration and foot ulcer associated with lower VAS scores. Other diabetes-related complications were not significantly associated with HRQL. Conclusions Our findings suggest that the impact of diabetes on HRQL in the Bangladeshi population is much higher than what is known from western populations and that unlike in western populations comorbidities/complications are not the driving factor for this effect

The Molecular Genetic Architecture of Self-Employment

Economic variables such as income, education, and occupation are known to affect mortality and morbidity, such as cardiovascular disease, and have also been shown to be partly heritable. However, very little is known about which genes influence economic variables, although these genes may have both a direct and an indirect effect on health. We report results from the first large-scale collaboration that studies the molecular genetic architecture of an economic variable-entrepreneurship-that was operationalized using self-employment, a widely-available proxy. Our results suggest that common SNPs when considered jointly explain about half of the narrow-sense heritability of self-employment estimated in twin data (σg2/σP2= 25%, h2= 55%). However, a meta-analysis of genome-wide association studies across sixteen studies comprising 50,627 participants did not identify genome-wide significant SNPs. 58 SNPs with p<10-5were tested in a replication sample (n = 3,271), but none replicated. Furthermore, a gene-based test shows that none of the genes that were previously suggested in the literature to influence entrepreneurship reveal significant associations. Finally, SNP-based genetic scores that use results from the meta-analysis capture less than 0.2% of the variance in self-employment in an independent sample (p≥0.039). Our results are consistent with a highly polygenic molecular genetic architecture of self-employment, with many genetic variants of small effect. Although self-employment is a multi-faceted, heavily environmentally influenced, and biologically distal trait, our results are similar to those for other genetically complex and biologically more proximate outcomes, such as height, intelligence, personality, and several diseases

The Molecular Genetic Architecture of Self-Employment

Peer reviewe

Prediction results.

<p>Variance explained (Nagelkerke pseudo-<i>R</i>² from logistic regression) vs. <i>p</i>-value threshold <i>p</i>_T for including SNPs in the score calculation.</p

Descriptive statistics of the sixteen discovery studies and the replication study.

<p>AGES: Age, Gene/Environment Susceptibility–Reykjavik Study; ASPS: Austrian Stroke Prevention Study; ERF: Erasmus Rucphen Family study; GHS: Gutenberg Health Study; H2000: Health 2000; HBCS: Helsinki Birth Cohort Study; HRS: Health and Retirement Study; KORA S4: Cooperative Health Research in the Region of Augsburg; NFBC1966: Northern Finland Birth Cohort 1966; NTR1: Netherlands Twin Register Cohort 1; NTR2: Netherlands Twin Register Cohort 2; RS-I: Rotterdam Study Baseline; RS-II: Rotterdam Study Extension of Baseline; RS-III: Rotterdam Study Young; SardiNIA: SardiNIA Study of Aging; SHIP: Study of Health in Pomerania; THISEAS: The Hellenic study of Interactions between SNPs & Eating in Atherosclerosis Susceptibility; TwinsUK: the UK Adult Twin Registry; YFS: the Cardiovascular Risk in Young Finns Study; STR: Swedish Twin Registry; Cases: number of participants that were at least once self-employed; Controls: number of participants that were not, and ideally never, self-employed; SD: standard deviation.</p>a<p>The number of male participants was insufficient for a male stratified analysis.</p