title: Are Ethnic Disparities in HbA1c Levels Explained by Mental Wellbeing? Analysis of Population-Based Data from the Health Survey for England.
abstract: It is unclear how ethnic differences in HbA1clevels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA1cdisparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning.
  
  
  
  Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA1cdata were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates.
  
  
  
  Ethnicity directly predicted blood sugar control (unadjusted coefficient -2.15; 95% CI -3.64, -0.67), with Caucasians generating lower average HbA1clevels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient -0.32; 95% CI -0.49, -0.16), and greater perceived energy predicted lower HbA1clevels (unadjusted coefficient -0.92; 95% CI -1.29, -0.55). This mediator effect accounted for just over 14% of the HbA1cvariance and was negated after adjusting for BMI.
  
  
  
  Caucasian experience better HbA1clevels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians.
authors.affiliation: School of Natural Sciences & Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK. f.k.umeh@ljmu.ac.uk.
authors.forename: Kanayo
authors.initials: K
authors.lastname: Umeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Energy; Ethnicity; HbA1c; Mental wellbeing