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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 10/2010

01-10-2010 | Original Research

Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

Authors: Cheryl P. Lynch, MD, MPH, Mulugeta Gebregziabher, PhD, Carrae Echols, MS, Gregory E. Gilbert, MSPH, Yumin Zhao, MS, Leonard E. Egede, MD, MS

Published in: Journal of General Internal Medicine | Issue 10/2010

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Abstract

BACKGROUND

Racial differences in mortality among veterans with diabetes are less well characterized than those in the general population.

OBJECTIVE

To examine racial differences in all-cause mortality in a large sample of veterans with diabetes.

DESIGN

A retrospective cohort.

PARTICIPANTS

Participants comprised 8,812 veterans with type 2 diabetes.

MEASUREMENTS

The main outcome measure was time to death. The main predictor was race/ethnicity. Other risk factors (or covariates) included age, gender, marital status, employment, glycosylated hemoglobin (HgbA1c), and several ICD-9 coded physical and mental health comorbidities.

RESULTS

Average follow-up was 4.5 years; 64% of veterans were non-Hispanic whites (NHW), 97% male, and 84% at least 50 years old. The overall mortality rate was 15% and was significantly lower for non-Hispanic blacks (NHB). Baseline HgbA1c values also differed for NHW (mean = 7.05) and NHB (mean = 7.65) (p < 0.001). In sequentially-built models NHB race was associated with a lower risk of mortality with HR ranging 0.80-0.92. After adjusting for all significant covariates, the risk of mortality remained lower for NHB (HR = 0.84, 95% CI: 0.75, 0.94). Increased mortality risk was associated with age, not being employed or retired, poor glycemic control, cancer, Coronary Heart Disease (CHD), and anxiety disorder; while a lower risk was associated with being female and ever being married.

CONCLUSIONS

The risk of death among NHB veterans with diabetes remained significantly lower than that of NHW after controlling for important confounding variables. Future studies in the VA need to examine detailed contributions of patient, provider and system-level factors on racial differences in mortality in adults with diabetes, especially if the findings of this study are replicated at other sites or using national VA data.
Literature
1.
Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.
2.
Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413–20.PubMed
3.
Engelgau MM, Geiss LS, Saaddine JB, et al. The evolving diabetes burden in the United States. Ann Intern Med. 2004;140(11):945–50.PubMed
4.
Gregg EW, Gu Q, Cheng YJ, Narayan KM, Cowie CC. Mortality trends in men and women with diabetes, 1971 to 2000. Ann Intern Med. 2007;147(3):149–55.PubMed
5.
Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville: National Center for Health Statistics; 2009.
6.
Kirk JK, D'Agostino RB Jr, Bell RA, et al. Disparities in HgbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diab Care. 2006;29(9):2130–6.CrossRef
7.
Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421–31.PubMed
8.
Jha AK, Shlipak MG, et al. Racial differences in mortality among men hospitalized in the Veterans Affairs health care system. JAMA. 2001;285(3):297–303.CrossRefPubMed
9.
Polsky D, Lave J, Klusaritz H, et al. Is lower 30-day mortality posthospital admission among blacks unique to the Veterans Affairs health care system? Med Care. 2007;45(11):1083–9.CrossRefPubMed
10.
Volpp KG, Stone R, Lave JR, et al. Is thirty-day hospital mortality really lower for black veterans compared with white veterans? Health Serv Res. 2007;42(4):1613–31.CrossRefPubMed
11.
12.
13.
Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145(1):72–80.PubMed
14.
Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. Hoboken: John Wiley & Sons Inc.; 2002.
15.
Rothman KJ, Greenland S. Modern epidemiology. Philadelphia: Lippincott Williams and Wilkins; 1998.
16.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.CrossRefPubMed
17.
Wei LJ, Lin DY, Weissfeld L. Regression analysis of multivariate incomplete failure time data by modeling marginal distribution. J Am Stat Assoc. 1989;84:1065–73.CrossRef
18.
19.
Shalev V, Chodick G, Bialik M, Green MS, Heymann AD. In a population-based cohort of diabetes patients, men and women had similar risks for all-cause mortality. J Clin Epidemiol. 2007;60(1):86–93.CrossRefPubMed
20.
Ford ES, Li C, Little RR, Mokdad AH. Trends in A1C concentrations among U.S. adults with diagnosed diabetes from 1999 to 2004. Diab Care. 2008;31(1):102–4.CrossRef
21.
Vaccaro O, Stamler J, Neaton JD. Sixteen-year coronary mortality in black and white men with diabetes screened for the Multiple Risk Factor Intervention Trial (MRFIT). Int J Epidemiol. 1998;27(4):636–41.CrossRefPubMed
22.
Valdez R, Narayan KM, Geiss LS, Engelgau MM. Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults. Am J Public Health. 1999;89(11):1715–21.CrossRefPubMed
23.
Polsky D, Jha AK, Lave J, et al. Short- and long-term mortality after an acute illness for elderly whites and blacks. Health Serv Res. 2008;43(4):1388–402.CrossRefPubMed
24.
Wolinsky FD, Miller TR, An H, Brezinski PR, Vaughn TE, Rosenthal GE. Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes? BMC Health Serv Res. 2006;6:131.CrossRefPubMed
25.
Helmer D, Sambamoorthi U, Shen Y, et al. Opting out of an integrated healthcare system: dual-system use is associated with poorer glycemic control in veterans with diabetes. Prim Care Diabetes. 2008;2(2):73–80.CrossRefPubMed
26.
Johnson N. The racial crossover in comorbidity, disability, and mortality. Demography. 2000;37(3):267–83.CrossRefPubMed
27.
Mehrotra R, Kermah D, Fried L, Adler S, Norris K. Racial differences in mortality among those with CKD. J Am Soc Nephrol. 2008;19(7):1403–10.CrossRefPubMed
28.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–110.CrossRefPubMed
29.
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.CrossRefPubMed
30.
Hermos JA. Health outcomes for black and white patients in the Veterans Affairs health care system. JAMA. 2001;285(14):1837. Author reply 1837-1838.CrossRefPubMed
31.
Miech RA, Kim J, McConnell C, Hamman RF. A growing disparity in diabetes-related mortality U.S. trends, 1989–2005. Am J Prev Med. 2009;36(2):126–32.CrossRefPubMed
32.
Heisler M, Faul JD, Hayward RA, Langa KM, Blaum C, Weir D. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007;167(17):1853–60.CrossRefPubMed
33.
Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed. Hoboken: Wiley; 2002.
Metadata
Title
Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes
Authors
Cheryl P. Lynch, MD, MPH
Mulugeta Gebregziabher, PhD
Carrae Echols, MS
Gregory E. Gilbert, MSPH
Yumin Zhao, MS
Leonard E. Egede, MD, MS
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 10/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1405-y

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