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Diabetes Care 26:2392-2399, 2003
© 2003 by the American Diabetes Association, Inc.

Pathophysiology/Complications
Original Article

Racial Differences in Diabetic Nephropathy, Cardiovascular Disease, and Mortality in a National Population of Veterans

Bessie A. Young, MD, MPH1,2,3, Charles Maynard, PHD1,4 and Edward J. Boyko, MD, MPH1,2

1 Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington
2 Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
3 Northwest Kidney Centers, Seattle, Washington
4 Department of Health Services, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Bessie A. Young, MD, MPH, VA Puget Sound Health Care System, ERIC (152-E), 1660 S. Columbian Way, Seattle, WA 98108–157. E-mail: youngb{at}u.washington.edu

OBJECTIVE—To determine racial differences in the prevalence of diabetic nephropathy, cardiovascular disease (CVD), and risk of mortality in a national health care system.

RESEARCH DESIGN AND METHODS—A longitudinal cohort study was conducted in 429,918 veterans with diabetes. Racial minority groups were analyzed for baseline differences in prevalence of early diabetic nephropathy, diabetic end-stage renal disease (ESRD) and CVD, and longitudinal risk of mortality compared with Caucasians.

RESULTS—The 429,918 patients identified with diabetes were of the following racial groups: Caucasian (56.2%), African American (15.3%), Asian (0.5%), Native American (0.4%), and unknown race (21.4%). Minority individuals were, on average, younger and less likely to have CVD but were more likely to have renal disease than Caucasians. After adjustment for age, sex, and economic status, African Americans (adjusted odds ratio [OR] = 1.3, 95% CI 1.2–1.4) and Native Americans (1.5, 1.1–2.1) were more likely to have early diabetic nephropathy than Caucasians. Diabetic ESRD was more likely to be present in African Americans (1.9, 1.9–2.0), Hispanics (1.4, 1.3–1.4), Asians (1.8, 1.5–2.1), and Native Americans (1.9, 1.5–2.3) than Caucasians. Concurrently, the adjusted OR of CVD in racial minority groups was 27–49% less than in Caucasians, whereas the 18-month risk of mortality among people from most racial minority groups was 7–12% lower than in Caucasians.

CONCLUSIONS—We conclude that when access to care is comparable, microvascular complications, macrovascular disease, and subsequent death occur with different frequencies among various racial groups.

Abbreviations: BIRLS, Beneficiary Identification and Record Locator System • COPD, chronic obstructive pulmonary disease • CVD, cardiovascular disease • ESRD, end-stage renal disease • MRFIT, Multiple Risk Factor Intervention Trial • VA, Veterans Affairs


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