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The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors.
JAMA 1992; 268(21):3079-84JAMA

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.

Authors+Show Affiliations

Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md 21287-6231.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -