Evidence of ethnic variations in the relationships between routinely recorded clinical factors and T2D: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Evidence on ethnic differences in factors associated with type 2 diabetes (T2D) is mixed. We aimed to systematically review evidence on ethnic variations in the relationships between routinely recorded demographic and clinical factors and T2D. METHODS: We searched Medline Complete and Embase for observational studies published between 1990 and 2023 investigating ethnic differences in factors routinely recorded in clinical encounters associated with T2D. We used random and fixed-effects meta-analysis to quantitatively summarise effect sizes across studies where possible. Risk of bias and study quality were assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute tool. PROSPERO registration: CRD42023394148. FINDINGS: Searches identified 10,694 studies, of which, 54 (n = 10 332,949 individuals) were eligible for inclusion, including 12 suitable for meta-analysis. Included studies reported ethnic differences in age at T2D diagnosis, anthropometric measures, and factors associated with women's health. Compared to individuals of White ethnicity, people of diverse ethnic backgrounds had 2-4-fold higher incidence and prevalence of T2D and younger age of onset. Waist-to-hip ratio (WHR) was a better discriminator of T2D across all ethnic groups compared to body mass index (BMI). While the association between overweight/obese BMI and T2D was strongest for people of White ethnicity (OR 4.85 CI 3.53-6.68) followed by Black (OR 3.27 CI 2.48-4.30) and East Asian ethnicities (OR 3.06 CI 2.29-4.16), the association between WHR and T2D was strongest for people of Black (OR 2.74, CI 2.22-3.39) than for White ethnicities (OR 2.51, CI 2.30-2.74). Included studies highlighted the emerging importance of women-health-associated factors such as index of parity, birth weight and breastfeeding, especially among women of diverse ethnicities. CONCLUSION: Ratio measures of central adiposity may better identify T2D in ethnically diverse populations than measures of overall adiposity. Sex-specific factors must be considered when assessing T2D risk. FUNDING: Wellcome Trust Grant 218584/Z/19/Z.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.070 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.040 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".