Cardiorenal Complications in Young-Onset Type 2 Diabetes Compared Between White Americans and African Americans

OBJECTIVE To explore risks and associated mediation effects of developing chronic kidney disease (CKD) and heart failure (HF) in young- and usual-onset type 2 diabetes (T2D) between White Americans (WAs) and African Americans (AAs). RESEARCH DESIGN AND METHODS From U.S. medical records, 1,491,672 WAs and 31,133 AAs were identified and stratified by T2D age of onset (18–39, 40–49, 50–59, 60–70 years). Risks, mediation effects, and time to CKD and HF were evaluated, adjusting for time-varying confounders. RESULTS In the 18–39, 40–49, 50–59, 60–70 age-groups, the hazard ratios (of developing CKD and HF in AAs versus WAs were 1.21 (95% CI 1.17–1.26) and 2.21 (1.98–2.45), 1.25 (1.22–1.28) and 1.86 (1.75–1.97), 1.21 (1.19–1.24) and 1.54 (1.48–1.60), and 1.10 (1.08–1.12) and 1.11 (1.07–1.15), respectively. In AAs and WAs aged 18–39 years, time in years to CKD (8.7 [95% CI 8.2–9.1] and 9.7 [9.2–10.2]) and HF (10.3 [9.3–11.2] and 12.1 [10.6–13.5]) were, on average, 3.6 and 4.0 and 3.1 and 4.1 years longer compared with those diagnosed at age 60–70 years. Compared with females, AA males aged