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Key Determinants of Ethnic Differences in Diabetes Morbidity and Mortality

Thursday, 3 November, 2011 - 16:00
Campus: Brussels Humanities, Sciences & Engineering campus
Faculty: Social Sciences and Solvay Business School
Hadewijch Vandenheede
phd defence

Diabetes rates have towered and are ever increasing. In 2010 the number of persons affected with
diabetes was estimated at 285 million worldwide. This number is expected to be 438 million by
2030, an increase of over 50 %. Diabetes rates are unevenly distributed. Some population groups
carry a disproportionally heavy share of the diabetes burden. In this way it has been well
established that some ethnic groups are severely stricken. There is ample evidence both for
ethnic variation in diabetes morbidity and mortality. Yet Belgian studies on this topic are scarce.
This thesis aims at (partly) filling this lacuna by describing and quantifying ethnic differences in
diabetes morbidity and mortality in Belgium on one hand, and by establishing mechanisms that
play a role in these differences on the other. In this dissertation ethnicity is mainly used as an
indicator of a different societal background.

Results indicate differences in the prevalence of diabetes between native Belgians and persons of
Turkish and Moroccan origin, with the latter suffering unduly and relative differences being
particularly pronounced among women. The excess diabetes prevalence among persons of
Turkish and Moroccan origin is strongly related to lifestyle and socioeconomic determinants, in
particular to education. To probe further into possible mechanisms at stake and to gain insight
into the life-worlds of diabetes patients, this quantitative analysis was supplemented with a
qualitative focus on diabetes narratives and lifestyle accounts of women of Turkish and Belgian
origin with type 2 diabetes. Central in the lived experience of both groups of women is the
challenge to attain and remain balanced via (changes towards) healthy lifestyle behaviour. Yet
barriers to a healthy lifestyle are legion and not easy to dismantle. Facilitators of lifestyle change
are social support and the ease with which these adaptations can be incorporated into daily life.
Lifestyle accounts of women of Turkish origin furthermore reveal a strong retention to
traditional dietary habits and a swift changeover to a sedentary lifestyle upon migration,
suggesting an obesity- and diabetes-prone lifestyle.

The mortality studies demonstrate ethnic variation in diabetes mortality in the Brussels-Capital
Region, with people of North African origin having higher mortality. Ethnic differences are most
marked in women, mirroring patterns in diabetes morbidity. Among women, the ‘parity’ and
‘timing of fertility’ factors appear to play an important role in ethnic differences in diabetes
mortality. The excess diabetes mortality among men and women of North African origin is
furthermore associated with their generally less favourable educational profile and poorer
housing conditions. The strongest association is observed for education, indicating that
knowledge-related assets may be more important contributors to ethnic differences in diabetes
mortality than material conditions. The European cross-country mortality study shows that most
migrant groups have higher diabetes mortality compared to local-born populations. Particularly
high mortality rates are observed among migrants, for whom the country of birth is less affluent
than the country of residence, hinting at an aetiological role of socioeconomic change in
combination with difficulties of coping with this change.

Altogether, the results indicate that ethnic differences in diabetes morbidity and mortality have
an intricate basis in culture and society. Hence, to grapple with these issues, policy interventions
should be ecological in character and target the individual-, community- as well as society-level.
Lifestyle interventions should furthermore capitalize on the life-worlds of the target population
and be easy to implement into daily life.

PDF icon Vandenheede_a.pdf