- Email: [email protected]
Prediabetes, diabetes and unemployment
ARTICLE IN PRESS
PCD-635; No. of Pages 1
p r i m a r y c a r e d i a b e t e s x x x ( 2 0 1 7 ) x x x–x x x
Contents lists available at ScienceDirect
Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd
Letter to the Editor
Prediabetes, diabetes and unemployment We read with interest the article by Rautio et al. which has been recently published online in the journal Primary Care Diabetes [1]. This article objectively quantifies the relationship between varying exposure to unemployment and impaired glucose metabolism, suggesting a relation of unemployment and type 2 diabetes in men. In our recent work [2] we have, through a different type of data (extensive population data from official registers, without a longitudinal structure), detected a relationship between unemployment and the incidence of diabetes in the Czech Republic. This type of data did not allow us to analyse differences between men and women with this diagnosis. When thinking about the results of the work Rautio et al., we came up with four questions which we would like to respectfully pose to the authors. (1) Whether the authors had information on the weight gain of individual subjects, at least in recent years just before the study. It would be interesting to test whether higher weight gain is associated with the prediabetes and diabetes status (weight history can be a valuable proxy or predictor for changing diabetes status, but it is certainly possible that its effect interacts with the effect of unemployment). (2) Whether they have data available on the nature of employment that each subject last held before the study. Knowledge of this data could help estimate the likely differences in physical workload between previous employment and current unemployment. (3) Whether it would be worthwhile to study the interaction effects of unemployment not only with gender, but also with other explanatory variables such as physical activity level, body mass index, smoking history, education effects interact with uneployment. (4) Whether it would be valuable to attempt to quantify the impact of the unemployment period in more detail (e.g. via modern regression methods like GAM”). We recognize that, that in each group of “unemployed”, as they are defined in the article, there may be included individuals with a diametrically different number of unemployed days (for instance in the group of ≤1 year there can be an individual with 1 day, but also 268 days spent unemployed, that is, people with completely different probable impact of unemployment). We believe that such an analysis could bring illustrative and likely even more convincing results than this pioneering, interesting and beneficial work has already shown.
Please cite this article in press as: http://dx.doi.org/10.1016/j.pcd.2017.07.006
J.
ˇ Broz,
et
al.,
Conflicts of interest None. No funding resources were used.
references
[1] N. Rautio, et al., Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: a follow-up of the Northern Finland Birth Cohort 1966, Prim. Care Diabetes (2017), http://dx.doi.org/10.1016/j.pcd.2017.03.010. ˇ ˇ M. Brabec, D. Janícková ˇ [2] J. Broz, Zd’árská, et al., Incidence of diabetes mellitus narrowly correlates with unemployment rate during 2000–2012 in the Czech Republic, Cent. Eur. J. Public Health 24 (2016) 86–87.
Jan Brozˇ ∗ Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
a
Marek Brabec a,b Institute of Computer Science of the ASCR, v. v. i., Czech Republic b Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Czech Republic
Prediabetes,
Ondˇrej Lukácˇ ˇ ˇ Zd’árská Denisa Janícková Milan Kvapil Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic ∗ Corresponding
author. ˇ E-mail address: [email protected] (J. Broz) 28 June 2017 17 July 2017 1751-9918/© 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pcd.2017.07.006
diabetes
and
unemployment,
Prim.
Care
Diab.
(2017),
PCD-635; No. of Pages 1
p r i m a r y c a r e d i a b e t e s x x x ( 2 0 1 7 ) x x x–x x x
Contents lists available at ScienceDirect
Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd
Letter to the Editor
Prediabetes, diabetes and unemployment We read with interest the article by Rautio et al. which has been recently published online in the journal Primary Care Diabetes [1]. This article objectively quantifies the relationship between varying exposure to unemployment and impaired glucose metabolism, suggesting a relation of unemployment and type 2 diabetes in men. In our recent work [2] we have, through a different type of data (extensive population data from official registers, without a longitudinal structure), detected a relationship between unemployment and the incidence of diabetes in the Czech Republic. This type of data did not allow us to analyse differences between men and women with this diagnosis. When thinking about the results of the work Rautio et al., we came up with four questions which we would like to respectfully pose to the authors. (1) Whether the authors had information on the weight gain of individual subjects, at least in recent years just before the study. It would be interesting to test whether higher weight gain is associated with the prediabetes and diabetes status (weight history can be a valuable proxy or predictor for changing diabetes status, but it is certainly possible that its effect interacts with the effect of unemployment). (2) Whether they have data available on the nature of employment that each subject last held before the study. Knowledge of this data could help estimate the likely differences in physical workload between previous employment and current unemployment. (3) Whether it would be worthwhile to study the interaction effects of unemployment not only with gender, but also with other explanatory variables such as physical activity level, body mass index, smoking history, education effects interact with uneployment. (4) Whether it would be valuable to attempt to quantify the impact of the unemployment period in more detail (e.g. via modern regression methods like GAM”). We recognize that, that in each group of “unemployed”, as they are defined in the article, there may be included individuals with a diametrically different number of unemployed days (for instance in the group of ≤1 year there can be an individual with 1 day, but also 268 days spent unemployed, that is, people with completely different probable impact of unemployment). We believe that such an analysis could bring illustrative and likely even more convincing results than this pioneering, interesting and beneficial work has already shown.
Please cite this article in press as: http://dx.doi.org/10.1016/j.pcd.2017.07.006
J.
ˇ Broz,
et
al.,
Conflicts of interest None. No funding resources were used.
references
[1] N. Rautio, et al., Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: a follow-up of the Northern Finland Birth Cohort 1966, Prim. Care Diabetes (2017), http://dx.doi.org/10.1016/j.pcd.2017.03.010. ˇ ˇ M. Brabec, D. Janícková ˇ [2] J. Broz, Zd’árská, et al., Incidence of diabetes mellitus narrowly correlates with unemployment rate during 2000–2012 in the Czech Republic, Cent. Eur. J. Public Health 24 (2016) 86–87.
Jan Brozˇ ∗ Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
a
Marek Brabec a,b Institute of Computer Science of the ASCR, v. v. i., Czech Republic b Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Czech Republic
Prediabetes,
Ondˇrej Lukácˇ ˇ ˇ Zd’árská Denisa Janícková Milan Kvapil Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic ∗ Corresponding
author. ˇ E-mail address: [email protected] (J. Broz) 28 June 2017 17 July 2017 1751-9918/© 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pcd.2017.07.006
diabetes
and
unemployment,
Prim.
Care
Diab.
(2017),