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

Abstract

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.

Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans

“…The notion that similar blood pressure and glycaemic control may not have the same beneficial effects in these patients is in keeping with a recent report showing that, after adjustment for age, sex, geographic variations, cardiovascular disease and hypertension, African American veterans had a 30% higher risk of diabetic nephropathy than white Americans, despite similar therapy and the same targets being achieved in both groups [40]. The investigation of relative beneficial impacts of existing therapies on microvascular function and identification of alternative novel cardiovascular risk factors present in African Caribbeans may have profound effects on future treatment strategies for these patients.…”

Estrogens and the diabetic kidney

“…In African Americans, Hispanics, and Pima Indians, women are at greater risk for developing type 2 DM and associated end-stage renal disease than are men. [31][32][33] These women also have a higher mortality rate from heart disease than do men. 34,35 In American Indians, using analysis models controlled for age, treatment with oral hypoglycemic agents, HbA 1C concentration, blood pressure, obesity, and duration of diabetes, low concentrations of high-density lipoproteins were reported to be a risk factor for the development of albuminuria in women but not in men with type 2 DM.…”

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

“…[3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality. 2,[13][14][15][16][17] The etiology of these racial disparities is multifactorial involving health system, provider, and patient factors, all within the context of broader social issues.…”