Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients
A population-based cohort study
- Baiju R. Shah, MD, PHD1,2,3⇑,
- J. Charles Victor, MSC1,
- Maria Chiu, PHD1,2,
- Jack V. Tu, MD, PHD1,2,3,
- Sonia S. Anand, MD, PHD4,
- Peter C. Austin, PHD1,2,
- Douglas G. Manuel, MD, MSC1,5,6 and
- Janet E. Hux, MD, SM1,2,3
- 1Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- 2University of Toronto, Toronto, Ontario, Canada
- 3Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- 4McMaster University, Hamilton, Ontario, Canada
- 5University of Ottawa, Ottawa, Ontario, Canada
- 6Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Corresponding author: Baiju R. Shah, .
OBJECTIVE Many non-European ethnic groups have an increased risk for diabetes; however, the published literature demonstrates considerable uncertainty about the rates of diabetes complications among minority populations. The objective of this study was to determine the risks of cardiovascular complications and of mortality after diabetes diagnosis for South Asian and Chinese patients, compared with European patients.
RESEARCH DESIGN AND METHODS A population-based cohort study identified all 491,243 adults with newly diagnosed diabetes in Ontario, Canada, between April 2002 and March 2009. Subjects were followed until March 2011 for the first occurrence of any cardiovascular complication of diabetes (coronary artery disease, stroke, or lower-extremity amputation) and for all-cause mortality. Median follow-up was 4.7 years.
RESULTS The crude incidence of cardiovascular complications after diabetes diagnosis was 17.9 per 1,000 patient-years among European patients, 12.0 among South Asian patients, and 7.7 among Chinese patients. After adjusting for baseline characteristics, the cause-specific hazard ratios (HRs) for cardiovascular complications relative to European patients were 0.95 (95% CI 0.90–1.00; P = 0.056) and 0.50 (0.46–0.53; P < 0.001) for South Asian and Chinese patients, respectively. Mortality was lower for both minority groups (adjusted HR for South Asian patients 0.56 [95% CI 0.52–0.60]; P < 0.001; for Chinese patients 0.58 [0.55–0.62]; P < 0.001).
CONCLUSIONS Chinese patients were at substantially lower risk than European patients for cardiovascular complications after diabetes diagnosis, whereas South Asian patients were at comparable risk. Mortality after diabetes diagnosis was markedly lower for both minority populations.
- Received October 15, 2012.
- Accepted March 17, 2013.
- © 2013 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.