Background:
Although coronary heart disease (CHD), heart failure (HF), stroke, and end-stage renal disease (ESRD) are major microvascular and macrovascular complications of diabetes, they are less clear for diabetic subgroups especially on those with middle and low income.
Aim:
To investigate racial disparities in the incidence of diabetic complications in middle and low income adults.
Methods:
We performed a prospective cohort study (1985-2010) on diabetic patients enrolled in the LSU Hospital-Based Longitudinal Study. Study cohorts included 89,353 diabetic patients (16,326 White men, 21,496 White women, 19,422 African American men and 32,109 African American women) who were 30 to 96 years of age. We calculated the gender specific age-standardized incident rates using the direct method to the year 2010 Census population. Cox proportional hazard models were used to compare racial or gender specific hazard ratios for CHD, HF, stroke and ESRD after adjustment for age, race, type of health insurance, family income, body mass index, smoking, systolic blood pressure, LDL cholesterol, HDL cholesterol, HbA
1c
, estimated GFR, albuminuria, and drug treatments for diabetes, hypertension and hyperlipidemia.
Results:
During an average 4.0 years of follow-up, 16,935 CHD, 13,421 HF, 6,804 stroke, and 13,281 ESRD incident cases were ascertained. The age-standardized incident rates of the four diabetic complications are presented in
table 1
. Compared with White diabetic patients, African Americans experienced higher rates of ESRD and lower rates of CHD, HF, and stroke. Female diabetic patients had lower rates of the four complications than males. Results of the Cox proportional hazard models confirmed the racial disparity and gender difference we found in the age-standardized incident rates.
Conclusions:
The results support the existence of racial differences in the incidence of diabetic complications in this population.
Table 1
Age-adjusted incident rates of type 2 diabetes complications in the LSUHLS study
Age-standardized incident rates
White
African American
Male
Female
Male
Female
Coronary Heart Disease
101.6 (98.8-104.5)
62.0 (60.4-63.7)
50.7 (49.2-52.2)
44.4 (43.4-45.5)
Heart Failure
54.9 (52.9-56.8)
41.9 (40.6-43.1)
43.4 (42.0-44.8)
38.4 (37.4-39.3)
Stroke
22.1 (20.9-23.3)
20.7 (19.8-21.6)
19.9 (19.0-20.8)
18.5 (17.8-19.1)
End-stage Renal Disease
43.3 (41.6-45.0)
33.4 (32.2-34.5)
51.4 (50.0-52.9)
35.2 (34.3-36.1)
Number of Attributed Reasons for Everyday Discrimination and Mortality Among Older Blacks
