Ethnic Disparities in Diabetic Complications in an Insured Population

Karter, Andrew J.; Ferrara, Assiamira; Liu, Jennifer Y.; Moffet, Howard H.; Ackerson, Lynn; Selby, Joe V.

doi:10.1001/jama.287.19.2519

Cited by 751 publications

(627 citation statements)

References 66 publications

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“…Although there is some evidence of racial and ethnic disparities in complications of DM,17, 18, 19 we did not find any racial and ethnic differences in the incidence of any of the 5 cardiovascular outcomes or all‐cause mortality. Racial and ethnic disparities in DM complications can be explained by differences in access to health care, financial barriers to quality health care or health insurance, and comprehensive coverage 18.…”

Section: Discussioncontrasting

confidence: 79%

“…Racial and ethnic disparities in DM complications can be explained by differences in access to health care, financial barriers to quality health care or health insurance, and comprehensive coverage 18. The lack of racial and ethnic disparities observed in our study may be attributable to relatively favorable selection of an insured population, such as that of Medicare beneficiaries with ESRD, in which financial barriers to health care are not as prominent, as they are seen regularly or at least monthly by a nephrologist.…”

Section: Discussionmentioning

confidence: 99%

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Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Montez‐Rath

et al. 2017

JAHA

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BackgroundThere is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus.Methods and ResultsWe included adult Medicare‐insured patients with diabetes mellitus who initiated in‐center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time‐averaged glycated hemoglobin (HbA1c) values were categorized into <48 mmol/mol (<6.5%) (reference), 48 to <58 mmol/mol (6.5% to <7.5%), 58 to <69 mmol/mol (7.5% to <8.5%), and ≥69 mmol/mol (≥8.5%). Medicare claims were used to identify outcomes of cardiovascular mortality, nonfatal myocardial infarction (MI), fatal or nonfatal MI, stroke, and peripheral arterial disease. We used Cox models as a function of time‐varying exposure to estimate multivariable adjusted hazard ratios and 95%CI for the associations between HbA1c and time to study outcomes in a cohort of 16 387 eligible patients. Patients with HbA1c 58 to <69 mmol/mol (7.5% to <8.5%) and ≥69 mmol/mol (≥8.5%) had 16% (CI, 2%, 32%) and 18% (CI, 1%, 37%) higher rates of cardiovascular mortality (P‐trend=0.01) and 16% (CI, 1%, 33%) and 15% (CI, 1%, 32%) higher rates of nonfatal MI (P‐trend=0.05), respectively, compared with those in the reference group. Patients with HbA1c ≥69 mmol/mol (≥8.5%) had a 20% (CI, 2%, 41%) higher rate of fatal or nonfatal MI (P‐trend=0.02), compared with those in the reference group. HbA1c was not associated with stroke, peripheral arterial disease, or all‐cause mortality.ConclusionsHigher HbA1c levels were significantly associated with higher rates of cardiovascular mortality and MI but not with stroke, peripheral arterial disease, or all‐cause mortality in this large cohort of hemodialysis patients with diabetes mellitus.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Montez‐Rath

et al. 2017

JAHA

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“…In a recent meta-analysis, Asians were found to have a lower risk of developing cardiovascular disease but a higher risk of renal disease than Caucasians [22,23]. In the present analysis, patients with chronic HBV infection were younger, had earlier onset of disease and were more likely to be insulin-treated and have retinopathy at baseline.…”

Section: Discussionmentioning

confidence: 47%

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

et al. 2006

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Aims/hypothesis: We examined the association between chronic hepatitis B virus (HBV) infection and clinical outcomes in a consecutive cohort of Chinese patients with type 2 diabetes. Subjects, materials and methods: Between 1995 and 1999, 2,838 type 2 diabetes patients underwent comprehensive assessments and blood screening for hepatitis B surface antigen (HBsAg). The risk of occurrence of cardiovascular events and end-stage renal disease (defined as need for dialysis, doubling of serum creatinine or serum creatinine ≥500 μmol/l) was compared between HBsAg-positive and HBsAg-negative groups. Results: At baseline, HBV-infected patients (n=286, 10.1%) were younger (51.0±11.5 vs 53.7±12.7 years, p=0.004), had earlier onset of diabetes (51.0±11.5 vs 53.7±12.7 years, p=0.001) and a higher frequency of retinopathy (28 vs 22%, p=0.03) than non-HBV-infected patients. After a median follow-up of 3.5 years (interquartile range: 1.7-5.9 years) and adjustment of age, glycaemic control and other potential confounding factors, HBV-infected patients were more likely to develop end-stage renal disease than non-HBV infected patients (8.7 vs 6.4%) with a hazard ratio of 4.5 (95% CI 1.1-18.6). The difference in the frequency of cardiovascular endpoints was not statistically significant. Conclusions: In Chinese type 2 diabetes patients, chronic HBV infection was associated with increased risk of end-stage renal disease, and this was independent of other potential confounding factors. Early identification of HBV status and close surveillance of renal function are important in patients with type 2 diabetes who are living in areas where HBV is endemic or who are at risk of chronic HBV infection.

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“…aspects of an individual's social and environmental life context that fall outside of the health care setting-may contribute to perpetuating health disparities. 1,[6][7][8][9][10] Given the widely-reported associations between contextual influences, particularly neighborhood characteristics 6,[11][12][13] , and health behaviors in general, it is plausible that unfavorable contextual influences promote poor diabetes outcomes by creating barriers to patient adherence to diabetes selfmanagement regimens.…”

Section: Introductionmentioning

confidence: 99%

Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes

Billimek

Sorkin

2011

J GEN INTERN MED

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Ethnic Disparities in Diabetic Complications in an Insured Population

Cited by 751 publications

References 66 publications

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes

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