Race and sex differences in rates of diabetic complications

Background Studies on racial differences in diabetic complications are very limited. The aim of this study was to investigate the race and sex differences in diabetic complications between African Americans and Whites with type 2 diabetes (T2D) in Louisiana. Methods A prospective cohort study was performed of 27 113 African Americans and 40 431 Whites with T2D who were 35 to 95 years of age from three healthcare systems located in south Louisiana. Four major diabetic complications were assessed: coronary heart disease (CHD), heart failure, stroke, and end‐stage renal disease (ESRD). Results The age‐ and sex‐adjusted incident rates per 1000 person‐years and 95% confidence intervals (CI) for CHD, heart failure, stroke, and ESRD for African Americans with diabetes were 43.1 (95% CI 41.6‐44.6), 36.6 (95% CI 35.2‐37.9), 29.6 (95% CI 28.4‐30.8), and 38.3 (95% CI 36.9‐39.7), respectively. Cox regression models showed that African American women had a higher risk than White women for heart failure (hazard ratio (HR) 1.26; 95% CI 1.18‐1.34), stroke (HR 1.15; 95% CI 1.08‐1.22), and ESRD (HR 1.32; 95% CI 1.24‐1.40), whereas African American men had higher risks than White men for heart failure (HR 1.33; 95% CI 1.25‐1.43) and ESRD (HR 1.47; 95% CI 1.37‐1.57) but a lower risk of CHD (HR 0.88; 95% CI 0.83‐0.94). Conclusions The incidence of major diabetic complications varied among difference race and sex groups. More race‐ or sex‐specific studies on complications in patients with diabetes are needed to see whether incident rates are changing over time. 摘要 背景 目前有关糖尿病并发症种族差异的研究非常有限。本研究旨在路易斯安那州患有2型糖尿病的非裔美国人与白种人中，调查糖尿病并发症的种族与性别差异。 方法 这是一项前瞻性的队列研究，纳入了患有2型糖尿病的27113名非裔美国人与40431名白种人，他们的年龄为35至95岁，来自路易斯安那州南部的3个医疗机构。评估了4种主要的糖尿病并发症:冠心病(coronary heart disease，CHD)、心力衰竭、中风以及终末期肾病(end‐stage renal disease，ESRD)。 结果 在患有糖尿病的非裔美国人中，校正年龄与性别后，每1000人‐年的CHD、心力衰竭、中风以及ESRD的发生率与95%置信区间(CI)分别为43.1(95% CI为41.6‐44.6)、36.6(95% CI为35.2‐37.9)、29.6(95% CI为28.4‐30.8)与38.3(95% CI为36.9‐39.7)。使用Cox回归模型分析后发现，非裔美国妇女与白种妇女相比，前者出现心力衰竭(风险比[HR]为1.26；95% CI为1.18‐1.34)、中风(HR为1.15；95% CI为1.08‐1.22)以及ESRD(HR为1.32；95% CI为1.24‐1.40)的风险都更高，而非裔美国男性与白种男性相比，前者出现心力衰竭(HR为1.33；95% CI为1.25‐1.43)与ESRD(HR为1.47；95% CI为1.37‐1.57)的风险都更高，但是出现CHD(HR为0.88；95% CI为0.83‐0.94)的风险却较低。 结论 在不同的种族与性别组中主要糖尿病并发症的发病率都各不相同。为了观察发病率是否会随着时间而变化，需要在糖尿病患者中进行更多的种族或者性别特异性的并发症研究。 Highlights A large prospective cohort study was conducted to test whether there were racial and sex differences in the incidence of major diabetic complications between African