Regional Variation in Cardiovascular Disease Risk Factors Among American Indians and Alaska Natives With Diabetes
- Stephen J. Rith-Najarian, MD1,
- Dorothy M. Gohdes, MD2,
- Raymond Shields, MD3,
- Betty Skipper, PHD4,
- Kelly R. Moore, MD5,
- Bernadine Tolbert, MD, PHD6,
- Terry Raymer, MD7 and
- Kelly J. Acton, MD, MPH8
- 1Bemidji Area Indian Health Service Diabetes Program, Bemidji, Minnesota
- 2Indian Health Service Diabetes Program, Albuquerque, New Mexico
- 3Portland Area Indian Health Service Diabetes Program, Bellingham, Washington
- 4Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
- 5Billings Area Indian Health Service Diabetes Program, Billings, Montana
- 6Oklahoma Area Office Indian Health Service Diabetes Program, Oklahoma City, Oklahoma
- 7California Area Diabetes Program, Trinidad, California
- 8Indian Health Service Diabetes Program, Albuquerque, New Mexico
Abstract
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 HbA1c (≥9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA1c (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA1c (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.
- CVD, cardiovascular disease
- IHS, Indian Health Service
- NHANES, National Health and Nutrition Examination Survey
- SHS, Strong Heart Study.
Footnotes
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Address correspondence and reprint requests to Stephen Rith-Najarian, Bemidji Area IHS Diabetes Program, Room 115 Federal Building, 522 Minnesota Ave., Bemidji, MN 56601. E-mail: srithnajrian{at}nchs.com.
Received for publication 9 May 2001 and accepted in revised form 6 November 2001.
D.M.G. or her immediate family holds stock in Pharmacia and Johnson & Johnson, and she has received honoraria from Bayer, Smith Klein Beecham, Aventis, Novartis, Bristol-Myers Squibb, Takeda, and Novo-Nordisk. At the time of this study, she was a consultant for the Indian Health Service Diabetes Program.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
