Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S - PubMed (original) (raw)

. 2019 Dec;42(12):2211-2219.

doi: 10.2337/dc19-0532. Epub 2019 Sep 19.

Margo A Sidell 3, David Arterburn 4, Matthew F Daley 5, Jay Desai 6, Stephanie L Fitzpatrick 7, Michael A Horberg 8, Corinna Koebnick 3, Emily McCormick 9, Caryn Oshiro 10, Deborah R Young 3, Assiamira Ferrara 11

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Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S

Yeyi Zhu et al. Diabetes Care. 2019 Dec.

Abstract

Objective: To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category.

Research design and methods: In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012-2013 were included. Diabetes and prediabetes were ascertained by diagnosis and laboratory results; antihyperglycemic medications were also included for diabetes ascertainment.

Results: The age-standardized diabetes and prediabetes prevalence estimates were 15.9% and 33.4%, respectively. Diabetes but not prediabetes prevalence increased across BMI categories among all racial/ethnic groups (P for trend < 0.001). Racial/ethnic minorities reached a given diabetes prevalence at lower BMIs than whites; Hawaiians/Pacific Islanders and Asians had a diabetes prevalence of 24.6% (95% CI 24.1-25.2%) in overweight and 26.5% (26.3-26.8%) in obese class 1, whereas whites had a prevalence of 23.7% (23.5-23.8%) in obese class 2. The age-standardized prediabetes prevalence estimates in overweight among Hispanics (35.6% [35.4-35.7%]), Asians (38.1% [38.0-38.3%]), and Hawaiians/Pacific Islanders (37.5% [36.9-38.2%]) were similar to those in obese class 4 among whites (35.3% [34.5-36.0%]), blacks (36.8% [35.5-38.2%]), and American Indians/Alaskan Natives (34.2% [29.6-38.8%]). In adjusted models, the strength of association between BMI and diabetes was highest among whites (relative risk comparing obese class 4 with normal weight 7.64 [95% CI 7.50-7.79]) and lowest among blacks (3.16 [3.05-3.27]). The association between BMI and prediabetes was less pronounced.

Conclusions: Racial/ethnic minorities had a higher burden of diabetes and prediabetes at lower BMIs than whites, suggesting the role of factors other than obesity in racial/ethnic disparities in diabetes and prediabetes risk and highlighting the need for tailored screening and prevention strategies.

© 2019 by the American Diabetes Association.

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Figures

Figure 1

Figure 1

Adjusted RRs (95% CIs) of diabetes by race/ethnicity and BMI categories in a logarithmic scale. Non-Asians were categorized as underweight (UW) (BMI <18.5 kg/m2), normal weight (NW) (18.5–24.9 kg/m2), overweight (OW) (25.0–29.9 kg/m2), and obese class (OC) 1–4 (30.0–34.9, 35.0–39.9, 40.0–49.9, ≥50.0 kg/m2), and Asians were categorized as UW (<18.5 kg/m2), NW (18.5–22.9 kg/m2), OW (23.0–27.4 kg/m2), and OC 1–4 (27.5–32.4, 32.5–37.4, 37.5–47.4, ≥47.5 kg/m2). Risk estimates were adjusted for age, sex, neighborhood poverty, neighborhood education, and site. Across BMI categories, P for trend < 0.001 for all groups after FDR adjustment for multiple comparisons. *P for interaction < 0.001 between race/ethnicity and BMI categories.

Figure 2

Figure 2

Adjusted RRs (95% CIs) of prediabetes by race/ethnicity and BMI categories in a logarithmic scale. Non-Asians were categorized as underweight (UW) (BMI <18.5 kg/m2), normal weight (NW) (18.5–24.9 kg/m2), overweight (OW) (25.0–29.9 kg/m2), and obese class (OC) 1–4 (30.0–34.9, 35.0–39.9, 40.0–49.9, ≥50.0 kg/m2), and Asians were categorized as UW (<18.5 kg/m2), NW (18.5–22.9 kg/m2), OW (23.0–27.4 kg/m2), and OC 1–4 (27.5–32.4, 32.5–37.4, 37.5–47.4, ≥47.5 kg/m2). Risk estimates were adjusted for age, sex, neighborhood poverty, neighborhood education, and site. Across BMI categories, P for trend < 0.001 for all groups after FDR adjustment for multiple comparisons. *P for interaction < 0.001 between race/ethnicity and BMI categories.

Comment in

References

    1. Centers for Disease Control and Prevention National Diabetes Statistics Report, 2017: estimates of diabetes and its burden in the United States. Atlanta, GA, Department of Health and Human Services, Centers for Disease Control and Prevention, 2017
    1. American Diabetes Association Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033–1046 - PMC - PubMed
    1. Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care 2005;28:2280–2288 - PubMed
    1. Koh HK, Graham G, Glied SA. Reducing racial and ethnic disparities: the action plan from the department of health and human services. Health Aff (Millwood) 2011;30:1822–1829 - PubMed
    1. Mendola ND, Chen TC, Gu Q, Eberhardt MS, Saydah S. Prevalence of total, diagnosed, and undiagnosed diabetes among adults: United States, 2013-2016. NCHS Data Brief 2018:1–8 - PubMed

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