Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives — United States, 1996–2013

Abstract

BackgroundAmerican Indians and Alaska Natives (AI/AN) have the highest diabetes prevalence among any racial/ethnic group in the United States. Among AI/AN, diabetes accounts for 69% of new cases of end-stage renal disease (ESRD), defined as kidney failure treated with dialysis or transplantation. During 1982–1996, diabetes-related ESRD (ESRD-D) in AI/AN increased substantially and disproportionately compared with other racial/ethnic groups.MethodsData from the U.S. Renal Data System, the Indian Health Service (IHS), the National Health Interview Survey, and the U.S. Census were used to calculate ESRD-D incidence rates by race/ethnicity among U.S. adults aged ≥18 years during 1996–2013 and in the diabetic population during 2006–2013. Rates were age-adjusted based on the 2000 U.S. standard population. IHS clinical data from the Diabetes Cares and Outcomes Audit were analyzed for diabetes management measures in AI/AN.ResultsAmong AI/AN adults, age-adjusted ESRD-D rates per 100,000 population decreased 54%, from 57.3 in 1996 to 26.5 in 2013. Although rates for adults in other racial/ethnic groups also decreased during this period, AI/AN had the steepest decline. Among AI/AN with diabetes, ESRD-D incidence decreased during 2006–2013 and, by 2013, was the same as that for whites. Measures related to the assessment and treatment of ESRD-D risk factors also showed more improvement during this period in AI/AN than in the general population.Conclusion and implications for public health practiceDespite well-documented health and socioeconomic disparities among AI/AN, ESRD-D incidence rates among this population have decreased substantially since 1996. This decline followed implementation by the IHS of public health and population management approaches to diabetes accompanied by improvements in clinical care beginning in the mid-1980s. These approaches might be a useful model for diabetes management in other health care systems, especially those serving populations at high risk.

Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States

“…6 These numbers are projected to increase because of the increasing prevalence of diabetes, hypertension, and end stage renal disease. 7,8 It is estimated that 2% of Native Americans in the United States will develop SC within their lifetime. 9 The low prevalence of SC in Native American immunocompetent persons is similar to that of other non-white groups.…”

Diabetic Kidney Disease

“…A 54% decrease in diabetes-related kidney failure occurred between the years 1996 and 2013 among American Indians, a group with a historically high prevalence of diabetes and DKD. Interventions leading to this change included systematic implementation of guidelines for treatment of hypertension and diabetes, regular albuminuria testing, use of ACE inhibitors and ARBs, services to support nutrition, physical activity, and diabetes education (79).…”

Prevalence of skin cancer in Native American kidney transplant recipients

“…In 2016, Native Americans received 233 solid organ transplantations, 147 of which were kidney transplants . These numbers are projected to increase because of the increasing prevalence of diabetes, hypertension, and end stage renal disease . It is estimated that 2% of Native Americans in the United States will develop SC within their lifetime .…”