Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus

Axon, R. Neal; Gebregziabher, Mulugeta; Echols, Carrae; Gilbert, Gregory E.; Egede, Leonard E.

doi:10.1007/s11606-011-1752-3

Cited by 19 publications

(20 citation statements)

References 33 publications

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“…Service connected disability was defined as dichotomous (< 50 % versus 50 % or more) serving as proxy variable to measure copay status, as has been done in multiple prior studies. [25][26][27] We also included comorbidity variables, such as congestive heart failure, anemia, cancer, cerebrovascular disease, cardiovascular disease, hypertension, hypothyroidism, liver disease, lung disease, fluid and electrolyte disorders, obesity, peripheral vascular disease, substance abuse, depression, psychoses, and others (AIDS, rheumatoid arthritis, renal failure, peptic ulcer disease and bleeding, weight loss), and these were defined based on ICD-9 codes at entry into the cohort based on previously validated algorithms. 28 Comorbidities were defined as binary indicators for each comorbidity and collapsed into 0, 1, 2 or 3 or more.…”

Section: Primary Covariatesmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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BACKGROUND: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN: Longitudinal analysis of a retrospective cohort. SUBJECTS: A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES: Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS: Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/ electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63 CONCLUSIONS: Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.

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Section: Primary Covariatesmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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“…[16][17][18] For instance, in a recent retrospective US community-based claims database study involving . 50 000 patients on antihypertensive therapy, black participants without diabetes had BP control rates of 72% (, 140/90 mm Hg), while those with diabetes had control rates of 43% (, 130/80 mm Hg).…”

Section: Recent Epidemiologic Findings In Black Patientsmentioning

confidence: 99%

“…5000 veterans with type 2 diabetes mellitus and initially uncontrolled hypertension, black patients had a statistically significantly increased likelihood of poor BP control compared with non-Hispanic white patients (38% higher for goal BP , 140/90 mm Hg and 50% higher for goal BP , 130/80 mm Hg; both P , 0.0001). 17 …”

Section: Recent Epidemiologic Findings In Black Patientsmentioning

confidence: 99%

Hypertension in Black Patients: An Update

Kountz¹

2013

Postgraduate Medicine

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Black individuals are at high risk for hypertension and increased morbidity from cardiovascular and renal disease, in particular. Increased understanding of racial disparities in hypertension, in terms of risk factors, patient/physician behaviors, and treatment outcomes, is key to improving racially oriented care in black patients. Recent data suggest that black patients progress more rapidly from prehypertension to hypertension, highlighting the need for early and prompt intervention. Unfortunately, adherence to and persistence with antihypertensive therapy are generally poor in black patients and are compounded by the increased need for multidrug therapy in this patient population. Treatment strategies currently under investigation are focusing on methods to improve self-care behaviors and medication adherence. Because this is a constantly and rapidly evolving field of study, this article provides an update of recent findings that should be of relevance and interest to practicing clinicians.

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“…Similar patterns of persistent racial differences despite overall improvement have been observed in cross-sectional studies of blood glucose levels and cholesterol levels 4 . Longitudinal studies also show increased odds of poor blood pressure control over time among Non-Hispanic blacks compared to whites 5 . In addition to increased prevalence of cardiovascular risk factors, mortality from coronary heart disease and stroke remain higher for blacks than other racial/ethnic groups 6 .…”

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confidence: 98%

Vitamin D as a Mediator of Racial Differences in Blood Pressure

2011

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H ypertension is a cardinal risk factor for myocardial infarction, congestive heart failure, stroke, and death. Despite unfavorable trends in the prevalence of diabetes, obesity, and sedentary lifestyles, overall hypertension prevalence was stable at~29% between the 1999-2000 and 2007-2008 time periods 1,2 . This phenomenon has been attributed to improved hypertension awareness, higher treatment rates, and more intense regimens for hypertension. Unfortunately, overall hypertension prevalence among black Americans remains close to 40%, significantly higher than the level observed for whites and Hispanic groups 2,3 . Similar patterns of persistent racial differences despite overall improvement have been observed in cross-sectional studies of blood glucose levels and cholesterol levels 4 . Longitudinal studies also show increased odds of poor blood pressure control over time among Non-Hispanic blacks compared to whites 5 . In addition to increased prevalence of cardiovascular risk factors, mortality from coronary heart disease and stroke remain higher for blacks than other racial/ethnic groups 6 . Therefore, substantial interest exists to explain these persistent disparities and to devise interventions that can address them. In this issue of the Journal, Fiscella and colleagues present evidence that vitamin D deficiency is a potential mediator of racial differences in blood pressure between blacks and whites 7 . In an analysis of NHANES data from [2001][2002][2003][2004][2005][2006], they demonstrated that 25-hydroxyvitamin D (25-OH D) levels appeared to account for approximately one quarter of the difference in mean systolic blood pressure observed between black and white subjects. This study is notable because it is the largest and most robust to date to examine the effect of Vitamin D on racial disparities in blood pressure. The analysis is strengthened by a relatively large sample size with adequate power to detect differences between races based on vitamin D levels. The investigators also extensively adjusted for potential confounders of the relationship between black and white blood pressure measures.In addition to known effects on bone metabolism, Vitamin D has been the subject of intense investigation in recent years given interest in its other systemic effects. Observational studies have associated low vitamin D levels with increased risk for cancer, autoimmune diseases, diabetes, and cardiovascular disease including hypertension [8][9][10][11] While the findings in the present study are provocative, care should be taken in their interpretation. First, the crosssectional nature of the analysis precludes causal inferences. Though the investigators adjusted for key socio-demographic factors, patient-specific health conditions/behaviors, and biomarkers; the potential for bias and confounding remains. For example, information on psychosocial stress, medication non-adherence, and health literacy were not available for inclusion in this analysis. These factors have previously been implicated as mediators of rac...

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Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus

Abstract: Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.

Cited by 19 publications

References 33 publications

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

Hypertension in Black Patients: An Update

Vitamin D as a Mediator of Racial Differences in Blood Pressure

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