Abstract P352: Racial/Ethnic Differences in Cardiovascular Disease Outcomes among Patients with Hypertension or Type 2 Diabetes

Background: This study assesses racial/ethnic differences in CVD outcomes among patients with hypertension (HTN) or type 2 diabetes (T2DM) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexican, non-Hispanic black (NHB), and non-Hispanic White (NHW) in a large, mixed payer ambulatory care setting in northern California. Study Design: We estimated the rate of CVD incidence among adult patients with HTN (N=171,864) or T2DM (N=10,570), or both (N=36,589) using electronic health records between 2000-2013. Average follow-up was 4.5 years. CVD, including CHD (410-414), PVD (415, 440.2, 440.3, 443.9, 451, 453), and stroke (430-434), was defined by ICD-9 codes; HTN and T2DM were defined by ICD-9 codes, medication history, or two or more elevated blood pressure measures/abnormal glucose lab test results. Cox proportional hazard models were used to estimate hazard ratios for CHD, PVD, and stroke across race/ethnicity. Results: Among these patients, 10.5% developed CVD by the end of year 2013 (5.4% CHD, 3.4%PVD, 3.6% stroke). There was a gender difference in the risk of incident CHD. Among males, the age-adjusted hazard ratios for CHD were significantly higher for Asian Indians (HR: 1.3, 95% CI: 1.2-1.5) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.8, CI: 0.6-0.9) compared to NHWs. Among females, the age-adjusted hazard ratios for CHD were significantly higher for Mexican (HR: 1.3, CI: 1.1-1.5) and NHBs (HR: 1.7, CI: 1.4-2.0) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.5, CI: 0.4-0.7). NHB men and women also had significantly higher age-adjusted hazard ratios for PVD (men: HR: 1.5, CI: 1.2-1.9; women: HR: 1.6, CI: 1.3-1.9) and stroke (men: HR: 1.3, CI: 1.1-1.7; women: HR: 1.3, CI: 1.1-1.6) compared to NHWs. The age-adjusted hazard ratios for PVD and stroke were lower or equivalent to NHWs for all Asian subgroups and Mexican men and women. Patients with both HTN and T2DM were at elevated risk to develop CVD compared to patients with only one of the two conditions, regardless of their race/ethnicity. Conclusions: Compared to previous studies, we found less racial/ethnic variation in CVD outcomes, in particular stroke, among patients with HTN or T2DM. Our finding suggests the higher stroke incidence rates in several races/ethnicities are likely to be explained by the higher prevalence of HTN and T2DM among these groups. However, Asian Indian men and NHB and Mexican women with HTN or T2DM were at elevated risk for CHD compared to NHWs. Since the majority of patients in the study cohort had health insurance, further studies are needed to better understand the reasons for the observed racial/ethnic differences beyond disparities in access to health care. Special attention needs to be paid to patients with multiple conditions.

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Abstract MP49: Racial/Ethnic Differences in Receipt of Follow-up Care and Type 2 Diabetes Diagnosis Following Gestational Diabetes

Circulation ◽

10.1161/circ.137.suppl_1.mp49 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Julie K Bower ◽

Brittney Francis ◽

Seuli Bose-Brill ◽

Christina L Wassel

Keyword(s):

Type 2 Diabetes ◽

Ethnic Differences ◽

Screening Tests ◽

Diabetes Diagnosis ◽

Diabetes Screening ◽

Screening Services ◽

Race Ethnicity ◽

Racial Ethnic

Introduction: Gestational diabetes mellitus (GDM) affects up to 14% of pregnancies in the U.S. and is associated with a sevenfold increased lifetime risk for type 2 diabetes (T2D). Clinical guidelines recommend postpartum glucose screening 4-12 weeks after a GDM pregnancy, and re-screening every 1-3 years thereafter. However, an inadequate proportion of persons with GDM actually receive these screenings. Racial/ethnic differences in risk of developing T2D following GDM may partially be driven by differential receipt of screening services. The aim of this study was to examine racial/ethnic differences in subsequent development of T2D, receipt of screening services, and glycated hemoglobin (HbA1c) in a nationally representative sample of women with a GDM history. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2007-2014). Race/ethnicity, GDM and diabetes diagnosis, and receipt of diabetes screening tests were determined by self-report; HbA1c was measured using standard laboratory procedures. Associations of race/ethnicity with outcomes of interest were evaluated using linear, logistic, and Cox regression, with adjustment for demographic, clinical, and healthcare access factors. Results: Among 629 women with a history of GDM in NHANES, non-Hispanic Black women had 98% higher risk (95% CI (1.28, 3.08), p=0.003), and Hispanics about double the risk (HR = 2.04, 95% CI (1.25, 3.32), p=0.005) of developing T2D following GDM compared to non-Hispanic Whites. In fully adjusted models, this was attenuated slightly, although still statistically significantly greater risk for both non-Hispanic Black (p=0.05) and Hispanic (p=0.03) women. Both non-Hispanic Black and Hispanic women were less likely to report being screened for diabetes in the past 3 years. In adjusted linear regression models, among women who remained diabetes-free, non-Hispanic Blacks had 0.40-% point higher HbA1c (p=0.02), and Hispanics had 0.26-% point higher HbA1c (p<0.001) compared to non-Hispanic Whites. Additionally, the odds of prediabetes were 4.9-fold higher for non-Hispanic Blacks (p<0.001), and 2.4-fold greater for Hispanics (p=0.03) as compared to non-Hispanic Whites. Odds of undiagnosed diabetes (HbA1c>6.5%) were significantly higher in non-Hispanic Blacks (OR=3.3, p=0.05) and marginally greater in Hispanics (OR=3.5, p=0.07) compared to non-Hispanic Whites. Conclusions: Differential receipt of follow-up services by minority women may exacerbate observed disparities in the burden of T2D. In this study, racial/ethnic disparities were apparent with regards to T2D diagnosis, receipt of diabetes screening tests, and HbA1c. Additional investigation to identify underlying factors contributing to this observed disparity will be particularly important to inform recommendations to improve delivery of quality care equitably across population subgroups.

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Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey

BMJ Open ◽

10.1136/bmjopen-2014-007375 ◽

2015 ◽

Vol 5 (5) ◽

pp. e007375-e007375 ◽

Cited By ~ 12

Author(s):

S. D. Goonesekera ◽

M. H. Yang ◽

S. A. Hall ◽

S. C. Fang ◽

R. S. Piccolo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Community Health ◽

Ethnic Differences ◽

Treatment Patterns ◽

Diabetes Treatment ◽

Community Health Survey ◽

Type 2 Diabetes Treatment ◽

Racial Ethnic

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P1-087: Racial/ethnic differences in dementia risk in a large population of older type 2 diabetes patients: The Diabetes and Aging Study

Alzheimer s & Dementia ◽

10.1016/j.jalz.2012.05.363 ◽

2012 ◽

Vol 8 (4S_Part_4) ◽

pp. P136-P137

Author(s):

Elizabeth Mayeda ◽

Andrew Karter ◽

Elbert Huang ◽

Howard Moffet ◽

Priya John ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Differences ◽

Large Population ◽

Dementia Risk ◽

Aging Study ◽

Racial Ethnic ◽

Diabetes Patients

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Racial/ethnic differences in the burden of type 2 diabetes over the life course: a focus on the USA and India

Diabetologia ◽

10.1007/s00125-019-4968-0 ◽

2019 ◽

Vol 62 (10) ◽

pp. 1751-1760 ◽

Cited By ~ 5

Author(s):

Sherita H. Golden ◽

Chittaranjan Yajnik ◽

Sanat Phatak ◽

Robert L. Hanson ◽

William C. Knowler

Keyword(s):

Type 2 Diabetes ◽

Life Course ◽

Ethnic Differences ◽

The Usa ◽

The Life Course ◽

Racial Ethnic

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Multiple sleep dimensions and type 2 diabetes risk among women in the Sister Study: differences by race/ethnicity

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000652 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000652 ◽

Cited By ~ 1

Author(s):

Ketrell L McWhorter ◽

Yong-Moon Park ◽

Symielle A Gaston ◽

Kacey B Fang ◽

Dale P Sandler ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Minorities ◽

Sleep Latency ◽

Diabetes Risk ◽

Poor Sleep ◽

Increased Risk ◽

Race Ethnicity ◽

Racial Ethnic

ObjectivePoor sleep has been associated with type 2 diabetes. Since racial/ethnic minorities experience a disproportionately high prevalence of poor sleep and type 2 diabetes, we sought to determine the relationships between multiple sleep dimensions and incident type 2 diabetes and to investigate if these relationships vary by race/ethnicity.Research design and methodsProspective data were analyzed from the Sister Study, which enrolled 50 884 women from 2003 to 2009. Participants self-reported sleep duration, sleep latency, night awakenings, and napping at baseline, and a physician’s diagnosis of type 2 diabetes at follow-up. Multivariable-adjusted HRs and 95% CIs were estimated using Cox proportional hazards models.ResultsAmong the 39 071 eligible participants, 87% self-identified as white, 8% black and 5% Hispanic/Latina. The mean follow-up period was 8.5±2.1 years and 1785 type 2 diabetes cases were reported. The incidence rate per 1000 person-years was 5.4 for whites, 13.3 for blacks and 11.6 for Hispanics/Latinas. There was a positive but non-significant increased risk of type 2 diabetes among women who reported short sleep, latency >30 min and frequent night awakenings. In fully-adjusted models, frequent napping was associated with a 19% (HR 1.19, 95% CI 1.04 to 1.37) higher type 2 diabetes risk in the overall sample. Poor sleep among racial/ethnic minorities ranged from a 1.4-fold to a 3.2-fold higher type 2 diabetes risk than whites with recommended sleep.ConclusionsFrequent napping was associated with higher type 2 diabetes risk. Racial/ethnic minorities with poor sleep had a higher type 2 diabetes risk than whites with recommended sleep.

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