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Regional Variation in Cardiovascular Disease Risk Factors Among American Indians and Alaska Natives With Diabetes

¹ Bemidji Area Indian Health Service Diabetes Program, Bemidji, Minnesota
² Indian Health Service Diabetes Program, Albuquerque, New Mexico
³ Portland Area Indian Health Service Diabetes Program, Bellingham, Washington
⁴ Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
⁵ Billings Area Indian Health Service Diabetes Program, Billings, Montana
⁶ Oklahoma Area Office Indian Health Service Diabetes Program, Oklahoma City, Oklahoma
⁷ California Area Diabetes Program, Trinidad, California
⁸ Indian Health Service Diabetes Program, Albuquerque, New Mexico

OBJECTIVE—To compare by region risk factors for cardiovascular disease among American Indian populations with diabetes.

RESEARCH DESIGN AND METHODS—Trained providers from 185 federal, urban, and tribally operated facilities reviewed the records from systematic random samples of the patients included in the local diabetes registries in the 1998 Indian Health Service (IHS) Diabetes Care and Outcomes Audit. Selected measures of cardiovascular risk were aggregated by region and adjusted to calculate regional rates for patients <45 years of age (n = 2,595) and those aged 45 years (n = 8,294).

RESULTS—Among the younger group of patients with diabetes, the rates of elevated HbA_1c (9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA_1c (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA_1c (27%) were found in Alaska. Among patients aged 45 years, all measures including rates of proteinuria, cholesterol 200 mg/dl, and mean blood pressure 130/85 varied significantly among all regions. Tobacco use was highest in the Great Lakes (44%) and Great Plains (42%) regions and lowest in the Southwest (14%) and Colorado Plateau (8%) regions. Proteinuria was found most frequently in the Southwest (35%), Colorado Plateau (30%), and Pacific regions (35%). Older individuals with diabetes were more likely than younger individuals to have proteinuria and blood pressure 130/85.

CONCLUSIONS—American Indians and Alaska Natives with diabetes carry a large burden of potentially modifiable cardiovascular risk factors, but there is significant regional variation.

Abbreviations: CVD, cardiovascular disease • IHS, Indian Health Service • NHANES, National Health and Nutrition Examination Survey • SHS, Strong Heart Study.

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