Racial disparities in diabetic complications in an underinsured population

J Clin Endocrinol Metab. 2012 Dec;97(12):4446-53. doi: 10.1210/jc.2012-2378. Epub 2012 Sep 13.

Abstract

Context: It is unclear whether there is a racial difference in the incidence of diabetic complications in underinsured populations.

Objective: The objective of the study was to investigate racial disparities in the incidence of diabetic complications within the Louisiana State University (LSU) Hospital System.

Design and participants: This study (1997-2009) was conducted on a diabetic cohort enrolled in the LSU Hospital-Based Longitudinal Study. The cohort included 16,808 non-Hispanic white men, 21,983 non-Hispanic white women, 20,621 African-American men, and 33,753 African-American women who were 30-96 yr of age and had a mean value of family income of $9641/yr at baseline.

Results: The study cohort had a mean follow-up of 4.4 years. The age- and sex-adjusted incidence rates and 95% confidence intervals of end-stage renal disease (ESRD), coronary heart disease (CHD), heart failure (HF), and stroke for white diabetic patients were 15.1 (14.3-15.8), 80.9 (78.9-82.9), 48.0 (46.6-49.4), and 21.4 (20.5-22.2) per 1000 person-years, respectively. Compared with white diabetic patients, African-American diabetic patients experienced higher incident rates of ESRD [17.3 (16.6-18.0)] and lower rates of CHD [47.5 (46.3-48.6)], HF [40.7 (39.6-41.8)], and stroke [19.1 (18.4-19.9)]. Female diabetic patients had lower rates of the four complications than male diabetic patients. Results of the Cox proportional hazard models confirmed sex and race disparity observed in the age-adjusted incidence rates.

Conclusions: Despite equal access to care, diabetic African-Americans have a higher risk of ESRD than their white counterparts, whereas diabetic whites have higher risks of CHD, HF, and stroke than their African-American counterparts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Continental Population Groups* / statistics & numerical data
  • Diabetes Complications / epidemiology
  • Diabetes Complications / ethnology*
  • Female
  • Health Status Disparities*
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / ethnology
  • Louisiana / epidemiology
  • Male
  • Medically Uninsured / statistics & numerical data*
  • Middle Aged
  • Vulnerable Populations / ethnology
  • Vulnerable Populations / statistics & numerical data