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The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors.

Abstract

OBJECTIVE

To investigate whether the excess incidence of diabetic end-stage renal disease (ESRD) among African Americans could be explained by racial differences in putative ESRD risk factors.

DESIGN

Population-based, ecologic study using the 1981 and 1982 Maryland Statewide Household Hypertension Survey for data on risk factor prevalence.

PARTICIPANTS

A total of 2.1 million adults residing within the boundaries of the Maryland Regional ESRD Registry, grouped by race and ZIP code into 26 subpopulations.

MAIN OUTCOME MEASURE

Incidence rates of treatment for diabetic ESRD between 1980 and 1985 from the Maryland Regional ESRD Registry by subpopulation.

RESULTS

Between 1980 and 1985, 442 persons entered treatment for diabetic ESRD. At the level of the subpopulation, diabetic ESRD incidence was positively associated with black race (relative risk [RR], 3.42; 95% confidence interval [CI], 2.84 to 4.13), prevalence of diabetes (RR, 2.35; 95% CI, 1.92 to 2.87), prevalence of poorly controlled hypertension (RR, 1.80; 95% CI, 1.45 to 1.86), lack of a regular source of health care (RR, 1.82; 95% CI, 1.62 to 2.05), and lower socioeconomic status as indicated by lack of college education (RR, 1.41; 95% CI, 1.32 to 1.52) (all, P < .0001). After adjusting for these risk factors, black race remained strongly associated with the overall incidence of diabetic ESRD (RR, 2.70; 95% CI, 1.89 to 3.86; P < .0001). Further analyses suggested that this excess risk among blacks was confined to ESRD related to non-insulin-dependent diabetes (RR, 4.80; 95% CI, 3.09 to 7.46; P < .0001); blacks were at no higher risk than were whites for ESRD related to insulin-dependent diabetes (RR, 0.90; 95% CI, 0.52 to 1.55; P = .70).

CONCLUSIONS

These data suggest that the excess incidence of diabetic ESRD among blacks is not fully explained by a higher prevalence of diabetes or hypertension in blacks or by racial differences in age, socioeconomic status, or access to health care. Instead, they suggest an increased susceptibility to ESRD resulting from non-insulin-dependent diabetes among blacks as compared with whites.

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  • Authors+Show Affiliations

    ,

    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md 21287-6231.

    , , ,

    Source

    JAMA 268:21 1992 Dec 02 pg 3079-84

    MeSH

    Adult
    African Continental Ancestry Group
    Diabetes Mellitus, Type 1
    Diabetes Mellitus, Type 2
    Diabetic Nephropathies
    Health Services Accessibility
    Humans
    Incidence
    Kidney Failure, Chronic
    Maryland
    Middle Aged
    Poisson Distribution
    Prevalence
    Regression Analysis
    Risk Factors
    Socioeconomic Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    1433738

    Citation

    Brancati, F L., et al. "The Excess Incidence of Diabetic End-stage Renal Disease Among Blacks. a Population-based Study of Potential Explanatory Factors." JAMA, vol. 268, no. 21, 1992, pp. 3079-84.
    Brancati FL, Whittle JC, Whelton PK, et al. The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors. JAMA. 1992;268(21):3079-84.
    Brancati, F. L., Whittle, J. C., Whelton, P. K., Seidler, A. J., & Klag, M. J. (1992). The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors. JAMA, 268(21), pp. 3079-84.
    Brancati FL, et al. The Excess Incidence of Diabetic End-stage Renal Disease Among Blacks. a Population-based Study of Potential Explanatory Factors. JAMA. 1992 Dec 2;268(21):3079-84. PubMed PMID: 1433738.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors. AU - Brancati,F L, AU - Whittle,J C, AU - Whelton,P K, AU - Seidler,A J, AU - Klag,M J, PY - 1992/12/2/pubmed PY - 1992/12/2/medline PY - 1992/12/2/entrez SP - 3079 EP - 84 JF - JAMA JO - JAMA VL - 268 IS - 21 N2 - OBJECTIVE: To investigate whether the excess incidence of diabetic end-stage renal disease (ESRD) among African Americans could be explained by racial differences in putative ESRD risk factors. DESIGN: Population-based, ecologic study using the 1981 and 1982 Maryland Statewide Household Hypertension Survey for data on risk factor prevalence. PARTICIPANTS: A total of 2.1 million adults residing within the boundaries of the Maryland Regional ESRD Registry, grouped by race and ZIP code into 26 subpopulations. MAIN OUTCOME MEASURE: Incidence rates of treatment for diabetic ESRD between 1980 and 1985 from the Maryland Regional ESRD Registry by subpopulation. RESULTS: Between 1980 and 1985, 442 persons entered treatment for diabetic ESRD. At the level of the subpopulation, diabetic ESRD incidence was positively associated with black race (relative risk [RR], 3.42; 95% confidence interval [CI], 2.84 to 4.13), prevalence of diabetes (RR, 2.35; 95% CI, 1.92 to 2.87), prevalence of poorly controlled hypertension (RR, 1.80; 95% CI, 1.45 to 1.86), lack of a regular source of health care (RR, 1.82; 95% CI, 1.62 to 2.05), and lower socioeconomic status as indicated by lack of college education (RR, 1.41; 95% CI, 1.32 to 1.52) (all, P < .0001). After adjusting for these risk factors, black race remained strongly associated with the overall incidence of diabetic ESRD (RR, 2.70; 95% CI, 1.89 to 3.86; P < .0001). Further analyses suggested that this excess risk among blacks was confined to ESRD related to non-insulin-dependent diabetes (RR, 4.80; 95% CI, 3.09 to 7.46; P < .0001); blacks were at no higher risk than were whites for ESRD related to insulin-dependent diabetes (RR, 0.90; 95% CI, 0.52 to 1.55; P = .70). CONCLUSIONS: These data suggest that the excess incidence of diabetic ESRD among blacks is not fully explained by a higher prevalence of diabetes or hypertension in blacks or by racial differences in age, socioeconomic status, or access to health care. Instead, they suggest an increased susceptibility to ESRD resulting from non-insulin-dependent diabetes among blacks as compared with whites. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/1433738/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/268/pg/3079 DB - PRIME DP - Unbound Medicine ER -