1932

Abstract

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if () the PSR to psychosocial factors (especially social disparities) was recognized and () intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-031914-122921
2015-03-18
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/36/1/annurev-publhealth-031914-122921.html?itemId=/content/journals/10.1146/annurev-publhealth-031914-122921&mimeType=html&fmt=ahah

Literature Cited

  1. Acheson D. 1.  1998. Independent Inquiry into Inequalities in Health London: The Stationary Office
  2. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. 2.  2011. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int. J. Epidemiol. 40:804–18 [Google Scholar]
  3. Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V. 3.  et al. 2004. Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women. Diabetes Care 27:716–21 [Google Scholar]
  4. Alastalo H, Raikkonen K, Pesonen A-K, Osmond C, Barker DJP. 4.  et al. 2009. Cardiovascular health of Finnish war evacuees 60 years later. Ann. Med. 41:66–72 [Google Scholar]
  5. Anderson RJ, Clouse RE, Freedland KE, Lustman PJ. 5.  2001. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24:1069–78 [Google Scholar]
  6. Antonovsky A. 6.  1987. Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass
  7. Appels A. 7.  1990. Mental precursors of myocardial infarction. Br. J. Psychiatry 156:465–71 [Google Scholar]
  8. Arroyo C, Hu FB, Ryan LM, Kawachi I, Colditz GA. 8.  et al. 2004. Depressive symptoms and risk of type 2 diabetes in women. Diabetes Care 27:129–33 [Google Scholar]
  9. Atlantis E, Goldney RD, Wittert GA. 9.  2009. Obesity and depression or anxiety. Br. Med. J. 339:b3868 [Google Scholar]
  10. Bjorntorp P. 10.  1991. Visceral fat accumulation: the missing link between psychosocial factors and cardiovascular disease?. J. Intern. Med. 230:195–201 [Google Scholar]
  11. Black PH. 11.  2003. The inflammatory response is an integral part of the stress response: implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome. Brain Behav. Immun. 17:350–64 [Google Scholar]
  12. Carnethon MR, Biggs ML, Barzilay JI, Smith NL, Vaccarino V. 12.  et al. 2007. Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch. Intern. Med. 167:802–7 [Google Scholar]
  13. Carnethon MR, Kinder LS, Fair JM, Stafford RS, Fortmann SP. 13.  2003. Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971–1992. Am. J. Epidemiol. 158:416–23 [Google Scholar]
  14. Chandola T, Kuper H, Singh-Manoux A, Bartley M, Marmot M. 14.  2004. The effect of control at home on CHD events in the Whitehall II study: gender differences in psychosocial domestic pathways to social inequalities in CHD. Soc. Sci. Med. 58:1501–9 [Google Scholar]
  15. Chida Y, Steptoe A. 15.  2009. The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J. Am. Coll. Cardiol. 53:936–46 [Google Scholar]
  16. Cohen S, Kessler RC, Gordon LU. 16.  1995. Strategies for measuring stress in studies of psychiatric and physical disorders. Measuring Stress: A Guide for Health and Social Scientists S Cohen, RC Kessler, LU Gordon 3–28 Oxford: Oxford Univ. Press. [Google Scholar]
  17. Contrada RJ, Baum A. 17.  2011. The Handbook of Stress Science: Biology, Psychology and Health New York: Springer
  18. Cosgrove MP, Sargeant LA, Griffin SJ. 18.  2008. Does depression increase the risk of developing type 2 diabetes?. Occup. Med. 58:7–14 [Google Scholar]
  19. Dandona P, Aljada A, Bandyopadhyay A. 19.  2004. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 25:4–7 [Google Scholar]
  20. Daniels MC, Goldberg J, Jacobsen C, Welty TK. 20.  2006. Is psychological distress a risk factor for the incidence of diabetes among American Indians? The Strong Heart Study. J. Appl. Gerontol. 25:60S–72S [Google Scholar]
  21. Demakakos P, Nazroo J, Breeze E, Marmot M. 21.  2008. Socioeconomic status and health: the role of subjective social status. Soc. Sci. Med. 67:330–40 [Google Scholar]
  22. Dinan TG. 22.  2004. Stress and the genesis of diabetes mellitus in schizophrenia. Br. J. Psychiatry 184:S72–75 [Google Scholar]
  23. Donath MY, Shoelson SE. 23.  2011. Type 2 diabetes as an inflammatory disease. Nat. Rev. Immunol. 11:98–107 [Google Scholar]
  24. Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D. 24.  et al. 2003. Low-grade systemic inflammation and the development of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes 52:1799–805 [Google Scholar]
  25. Eriksson AK, Ekbom A, Granath F, Hilding A, Efendic S, Ostenson CG. 25.  2008. Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet. Med. 25:834–42 [Google Scholar]
  26. Newton RW, Ruta DA, MacDonald TM, Morris AD. 26.  Evans JMM, 2000. Socio-economic status, obesity and prevalence of type 1 and type 2 diabetes mellitus. Diabet. Med. 17:478–80 [Google Scholar]
  27. Everson-Rose SA, Lewis TT. 27.  2005. Psychosocial factors and cardiovascular diseases. Annu. Rev. Public Health 26:469–500 [Google Scholar]
  28. Everson-Rose SA, Meyer PM, Powell LH, Pandey D, Torrens JI. 28.  et al. 2004. Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife. Diabetes Care 27:2856–62 [Google Scholar]
  29. 29. Expert Group 2004. “Schizophrenia and diabetes 2003” expert consensus meeting, Dublin. 3–4 October 2003: consensus summary Br. J. Psychiatr. Suppl. 184:S112–14 [Google Scholar]
  30. Fisher EB, Thorpe CT, McEvoy DeVellis B, Devellis RF. 29a.  2007. Health coping, negative emotions, and diabetes management: a systematic review and appraisal. Diab. Educ 33:1080–103 [Google Scholar]
  31. Gaillard TR, Schuster DP, Bossetti BM, Green PA, Osei K. 30.  1997. Do sociodemographic and economic status predict risks for type II diabetes in African Americans?. Diabetes Educ. 23:294–300 [Google Scholar]
  32. Gibb J, Audet M-C, Hayley S, Anisman H. 31.  2009. Neurochemical and behavioral responses to inflammatory immune stressors. Front. Biosci. 1:275–95 [Google Scholar]
  33. Golden SH, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ. 32.  et al. 2008. Examining a bidirectional association between depressive symptoms and diabetes. J. Am. Med. Assoc. 299:2751–59 [Google Scholar]
  34. Golden SH, Williams JE, Ford DE, Yeh HC, Sanford CP. 34.  et al. 2004. Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 27:429–35 [Google Scholar]
  35. Golden SH, Williams JE, Ford DE, Yeh HC, Sanford CP. 33.  et al. 2006. Anger temperament is modestly associated with the risk of type 2 diabetes mellitus: the Atherosclerosis Risk in Communities study. Psychoneuroendocrinology 31:325–32 [Google Scholar]
  36. Goodwin RD, Davidson JR. 35.  2005. Self-reported diabetes and posttraumatic stress disorder among adults in the community. Prevent. Med. 40:570–74 [Google Scholar]
  37. Goodwin RD, Stein MB. 36.  2004. Association between childhood trauma and physical disorders among adults in the United States. Psychol. Med. 34:509–20 [Google Scholar]
  38. Heraclides A, Chandola T, Witte DR, Brunner EJ, Heraclides A. 37.  et al. 2009. Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women: evidence from the Whitehall II study. Diabetes Care 32:2230–35 [Google Scholar]
  39. Icks A, Moebus S, Feuersenger A, Haastert B, Jockel K-H, Giani G. 38.  2007. Diabetes prevalence and association with social status: widening of a social gradient? German national health surveys 1990–1992 and 1998. Diabetes Res. Clin. Pract. 78:293–97 [Google Scholar]
  40. Jiang L, Beals J, Whitsell NR, Roubideaux Y, Manson SM, AI-SUPERPFP Team. 39.  2007. Association between diabetes and mental disorders in two American Indian reservation communities. Diabetes Care 30:2228–29 [Google Scholar]
  41. Jiang L, Beals J, Whitsell NR, Roubideaux Y, Manson SM, AI-SUPERPFP Team. 40.  2008. Stress burden and diabetes in two American Indian reservation communities. Diabetes Care 31:427–29 [Google Scholar]
  42. Kato M, Noda M, Inoue M, Kadowaki T, Tsugane S. 41.  JPHC Study Group 2009. Psychological factors, coffee and risk of diabetes mellitus among middle-aged Japanese: a population-based prospective study in the JPHC study cohort. Endocr. J. 56:459–68 [Google Scholar]
  43. Kawakami N, Araki S, Takatsuka N, Shimizu H, Ishibashi H. 42.  1999. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J. Epidemiol. Community Health 53:359–63 [Google Scholar]
  44. Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. 43.  1999. Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care 22:1071–76 [Google Scholar]
  45. Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ. 44.  et al. 2006. Depression as a risk factor for the onset of type 2 diabetes mellitus: a meta-analysis. Diabetologia 49:837–45 [Google Scholar]
  46. Kouvonen AM, Vaananen A, Woods SA, Heponiemi T, Koskinen A, Toppinen-Tanner S. 45.  2008. Sense of coherence and diabetes: a prospective occupational cohort study. BMC Public Health 8:46 [Google Scholar]
  47. Kumari M, Head J, Marmot M. 46.  2004. Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study. Arch. Intern. Med. 164:1873–80 [Google Scholar]
  48. Kunz-Ebrecht SR, Kirschbaum C, Marmot M, Steptoe A. 47.  2004. Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort. Psychoneuroendocrinology 29:516–28 [Google Scholar]
  49. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. 48.  1998. Socioeconomic factors, health behaviours, and mortality. J. Am. Med. Assoc. 279:1703–8 [Google Scholar]
  50. Lidfeldt J, Hu FB, Manson JE, Kawachi I, Li TY. 49.  2007. A prospective study of childhood and adult socioeconomic status and incidence of type 2 diabetes in women. Am. J. Epidemiol. 165:882–89 [Google Scholar]
  51. Link CL, McKinlay JB. 50.  2009. Disparities in the prevalence of diabetes: Is it race/ethnicity or socioeconomic status? Results from the Boston Area Community Health (BACH) survey. Ethn. Dis. 19:288–92 [Google Scholar]
  52. Marmot M, Shipley M, Brunner E, Hemingway H. 51.  2001. Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study. J. Epidemiol. Community Health 55:310–17 [Google Scholar]
  53. Marmot MG, Kogevinas M, Elston MA. 52.  1991. Socioeconomic status and disease. Health Promotion Research: Towards a New Social Epidemiology B Badura, I Kickbusch 113–46 Copenhagen, Den.: World Health Organ. Reg. Off. Eur. [Google Scholar]
  54. Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA. 53.  2005. Education, income, occupation, and the 34-year incidence (1965–99) of type 2 diabetes in the Alameda County Study. Int. J. Epidemiol. 34:1274–81 [Google Scholar]
  55. Maty SC, Lynch JW, Raghunathan TE, Kaplan GA, Maty SC. 54.  et al. 2008. Childhood socioeconomic position, gender, adult body mass index, and incidence of type 2 diabetes mellitus over 34 years in the Alameda County Study. Am. J. Public Health 98:1486–94 [Google Scholar]
  56. McDermott S, Moran R, Platt T, Isaac T, Wood H, Dasari S. 55.  2005. Heart disease, schizophrenia, and affective psychoses: epidemiology of risk in primary care. Community Ment. Health J. 41:747–55 [Google Scholar]
  57. McEwen BS. 56.  1998. Stress, adaption, and disease: allostasis and allostatic load. Ann. N. Y. Acad. Sci. 840:33–44 [Google Scholar]
  58. Melamed S, Shirom A, Toker S, Shapira I. 57.  2006. Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons. Psychosom. Med. 68:863–69 [Google Scholar]
  59. Mezuk B, Eaton WW, Golden SH, Ding Y. 58.  2008. The influence of educational attainment on depression and risk of type 2 diabetes. Am. J. Public Health 98:1480–85 [Google Scholar]
  60. Misra A, Ganda OP. 59.  2007. Migration and its impact on adiposity and type 2 diabetes. Nutrition 23:696–708 [Google Scholar]
  61. Monden CWS. 60.  2005. Current and lifetime exposure to working conditions: Do they explain educational differences in subjective health?. Soc. Sci. Med. 60:2465–76 [Google Scholar]
  62. Morikawa Y, Nagagawa H, Miura K, Soyama Y, Ishizaki M. 61.  et al. 2005. Shift work and the risk of diabetes mellitus among Japanese male factory workers. Scan. J. Work Environ. Health 31:179–83 [Google Scholar]
  63. Nagaya T, Yoshida H, Takahashi H, Kawai M. 62.  2006. Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: a follow-up study in Japanese men. Am. J. Indus. Med. 49:30–35 [Google Scholar]
  64. Norberg M, Stenlund H, Lindah B, Andersson C, Eriksson JW, Weinehall L. 63.  2007. Work stress and low emotional support is associated with increased risk of future type 2 diabetes in women. Diabetes Res. Clin. Prac. 76:368–77 [Google Scholar]
  65. Olsen J, Li J, Precht DH. 64.  2005. Hospitalization because of diabetes and bereavement: a national cohort study of parents who lost a child. Diabet. Med. 22:1338–42 [Google Scholar]
  66. Orpana HM, Lemyre L, Kelly SJ. 65.  2007. Do stressors explain the association between income and changes in self-rated health? A longitudinal analysis of the National Population Health Survey. Int. J. Behav. Med. 14:40–47 [Google Scholar]
  67. Procopiou M, Philippe J. 66.  2005. The metabolic syndrome and type 2 diabetes: epidemiological figures and country specificities. Cerebrovasc. Dis. 20:2–8 [Google Scholar]
  68. Raikkonen K, Matthews KA, Kuller LH. 67.  2007. Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women: a comparison of World Health Organization, Adult Treatment Panel III, and International Diabetes Foundation definitions. Diabetes Care 30:872–77 [Google Scholar]
  69. Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M. 68.  et al. 2011. Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project. Scand. J. Public Health 39:561–70 [Google Scholar]
  70. Rich-Edwards JW, Spiegelman D, Lividoti Hibert E, Jun H-J, James Todd T. 69.  et al. 2010. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am. J. Prev. Med. 39:529–36 [Google Scholar]
  71. Robbins JM, Vaccarino V, Zhang H, Kasl SV. 70.  2001. Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. Am. J. Public Health 91:76–83 [Google Scholar]
  72. Robbins JM, Vaccarino V, Zhang H, Kasl SV. 71.  2005. Socioeconomic status and diagnosed diabetes incidence. Diabetes Res. Clin. Pract. 68:230–36 [Google Scholar]
  73. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M. 72.  et al. 2004. Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 364:953–62 [Google Scholar]
  74. Rosmond R, Bjorntorp P. 73.  2000. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J. Int. Med. 247:188–97 [Google Scholar]
  75. Rosmond R, Wallerius S, Wanger P, Martin L, Holm G, Bjorntorp P. 74.  2003. A 5-year follow-up study of disease incidence in men with an abnormal hormone pattern. J. Intern. Med. 254:386–90 [Google Scholar]
  76. Salminen JK, Saarijarvi S, Aarela E, Toikka T, Kauhanen J. 75.  1999. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J. Psychosom. Res. 46:75–82 [Google Scholar]
  77. Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ. 76.  et al. 1999. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 353:1649–52 [Google Scholar]
  78. Scott KM, Von Korff M, Alonso J, Angermeyer MC, Bromet E. 77.  et al. 2009. Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychol. Med. 39:33–43 [Google Scholar]
  79. Slavich GM, O'Donovan A, Epel ES, Kemeny ME. 78.  2010. Black sheep get the blues: a psychobiological model of social rejection and depression. Neurosci. Biobehav. Rev. 35:39–45 [Google Scholar]
  80. Soo H. 78a.  2009. Stress management training in diabetes mellitus. J. Health Psychol 14:933–43 [Google Scholar]
  81. Stellato RK, Feldman HA, Hamdy O, Horton ES, McKinlay JB. 79.  2000. Testosterone, sex hormone-binding globulin and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study. Diabetes Care 23:490–94 [Google Scholar]
  82. Strighini S, Tabak AG, Akbaraly TN, Sabia S, Shipley MJ. 80.  et al. 2012. Contribution of modifiable risk factors to social inequalities in type 2 diabetes: prospective Whitehall II cohort study. Br. Med. J. 345:e5452 [Google Scholar]
  83. Strodl E, Kenardy J. 81.  2006. Psychosocial and non-psychosocial risk factors for the new diagnosis of diabetes in elderly women. Diabetes Res. Clin. Pract. 74:57–65 [Google Scholar]
  84. Surtees P, Wainwright N, Luben R, Khaw KT, Day N. 82.  2003. Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom Prospective Cohort Study. Am. J. Epidemiol. 158:1202–9 [Google Scholar]
  85. Suwazono Y, Sakata K, Okubo Y, Harada H, Oishi M. 83.  et al. 2006. Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers. J. Occup. Environ. Med. 48:455–61 [Google Scholar]
  86. Tabassum F, Kumari M, Rumley A, Lowe G, Power C, Strachan DP. 84.  2008. Effects of socioeconomic position on inflammatory and hemostatic markers: a life-course analysis in the 1958 British birth cohort. Am. J. Epidemiol. 167:1332–41 [Google Scholar]
  87. Tamayo T, Christian H, Rathmann W. 85.  2010. Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health 10:525 [Google Scholar]
  88. Tanaka T, Gjonca E, Gulliford MC. 86.  2012. Income, wealth and risk of diabetes among older adults: cohort study using the English Longitudinal Study of Ageing. Eur. J. Public Health 22:310–17 [Google Scholar]
  89. Thomas C, Hypponen E, Power C. 87.  2007. Prenatal exposures and glucose metabolism in adulthood. Diabetes Care 30:918–24 [Google Scholar]
  90. Thomas C, Hypponen E, Power C. 88.  2008. Obesity and type 2 diabetes risk in midadult life: the role of childhood adversity. Pediatrics 121:e1240–49 [Google Scholar]
  91. Turner RJ, Avison WR. 89.  2003. Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender. J. Health Soc. Behav. 44:488–505 [Google Scholar]
  92. Ujcic-Voortman JK, Schram MT, Jacobs-van der Bruggen MA, Verhoeff AP, Baan CA. 90.  2009. Diabetes prevalence and risk factors among ethnic minorities. Eur. J. Public Health 19:511–15 [Google Scholar]
  93. Ursin H. 91.  1991. Psychobiology of stress and attachment: the biobehavioural view. Health Promotion Research: Towards a New Social Epidemiology B Badura, I Kickbusch 173–86 Copenhagen, Den.: World Health Organ. Reg. Off. Eur. [Google Scholar]
  94. van den Akker M, Schuurman A, Metsemakers J, Buntinx F. 92.  2004. Is depression related to subsequent diabetes mellitus?. Acta Psychiatr. Scand. 110:178–83 [Google Scholar]
  95. Wang Z, Rowley K, Best J, McDermott R, Taylor M, O'Dea K. 93.  2007. Hemostatic factors in Australian aboriginal and Torres Strait islander populations. Metab. Clin. Exp. 56:269–65 [Google Scholar]
  96. Wilkinson R. 94.  1996. Unhealthy Societies: The Afflictions of Inequality London: Routledge
  97. Wilkinson R, Marmot M. 95.  2003. The Solid Facts Copenhagen, Den.: World Health Organ. Reg. Off. Eur.
  98. Wilkinson RG. 96.  2005. The Impact of Inequality: How to Make Sick Societies Healthier London: New Press/Routledge
  99. Williams ED, Tapp RJ, Magliano DJ, Shaw JE, Zimmet PZ, Oldenburg BF. 97.  2010. Health behaviours, socioeconomic status and diabetes incidence: the Australian Diabetes Obesity and Lifestyle Study (AusDiab). Diabetologia 53:2538–45 [Google Scholar]
  100. 98. World Health Organ. MONICA Proj 1994. Ecological analysis of the association between mortality and major risk factors of cardiovascular disease. Int. J. Epidemiol. 23:505–16 [Google Scholar]
/content/journals/10.1146/annurev-publhealth-031914-122921
Loading
/content/journals/10.1146/annurev-publhealth-031914-122921
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error