Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos

Robert C. Kaplan, Rebecca J. Song, Juan Lin, Vanessa Xanthakis, Simin Hua, Ariel Chernofsky, Kelly R. Evenson, Maura E. Walker, Carmen Cuthbertson, Joanne M. Murabito, Christina Cordero, Martha Daviglus, Krista M. Perreira, Marc Gellman, Daniela Sotres-Alvarez, Ramachandran S. Vasan, Xiaonan Xue, Nicole L. Spartano, Yasmin Mossavar-Rahmani

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Non-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly. Methods: Clinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments. Results: Four independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50–70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults. Conclusions: The same four independent predictors – age, body mass index, hypertension and employment status – were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.

Original languageEnglish (US)
Article number1053
JournalBMC Public Health
Issue number1
StatePublished - Dec 2022
Externally publishedYes


  • Hispanic
  • Latino
  • diabetes
  • epidemiology
  • occupation
  • physical activity
  • risk factors

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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