title: Glycated hemoglobin as an indicator of social environmental stress among indigenous versus westernized populations.
abstract: BACKGROUND
  This study assessed whether glycated hemoglobin concentration, an indicator of psychogenic stress, differs between indigenous populations and non-indigenous reference groups.
  
  
  METHODS
  Multivariate and stratified analyses were undertaken of cross-sectional data from multi-center community-based diabetes diagnostic and risk factor screening initiatives in Canada and Australia. Population groups were Australian Aborigines (n = 116), Torres Strait Islanders (n = 156), Native Canadians (n = 155), Greek migrants to Australia (n = 117), and Caucasian Australians (n = 67). Measurements included fasting glycated hemoglobin (HbA(1c)) concentration, fasting and 2-h post-load glucose concentrations, body mass index, waist-to-hip ratio, and demographic variables.
  
  
  RESULTS
  Mean HbA(1c) concentrations were greater for indigenous groups than for Greek migrants and Caucasian Australians (P < 0. 0001). The covariate adjusted indigenous versus non-indigenous difference (95% CI) was 0.90 (0.58-1.22) percentage units, 18.2% higher for indigenous people. Stratified analyses indicated greater HbA(1c) for indigenous than for non-indigenous persons with normoglycemia (P = 0.009), impaired glucose tolerance (P = 0.097), and diabetes (P < 0.0001).
  
  
  CONCLUSIONS
  HbA(1c) concentrations are greater for indigenous than for non-indigenous groups. Social changes, low control, and living conditions associated with westernization may be inherently stressful at the biological level for indigenous populations in westernized countries.
authors.affiliation: Department of Health Behavior & Health Education, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA. mdaniel@sph.unc.edu
authors.forename: M
authors.initials: M
authors.lastname: Daniel
authors.forename: K
authors.initials: K
authors.lastname: O'Dea
authors.forename: K G
authors.initials: KG
authors.lastname: Rowley
authors.forename: R
authors.initials: R
authors.lastname: McDermott
authors.forename: S
authors.initials: S
authors.lastname: Kelly
mesh_terms: D000069:Acculturation; D000328:Adult; D000704:Analysis of Variance; D000886:Anthropometry; D001315:Australia; D015415:Biomarkers; D002170:Canada; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006115:Greece / Q000208:ethnology; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D013315:Stress, Psychological / Q000097:blood*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin