title: Regional variation in cardiovascular disease risk factors among American Indians and Alaska Natives with diabetes.
abstract: OBJECTIVE
  To compare by region risk factors for cardiovascular disease among American Indian populations with diabetes.
  
  
  METHODS
  Trained providers from 185 federal, urban, and tribally operated facilities reviewed the records from systematic random samples of the patients included in the local diabetes registries in the 1998 Indian Health Service (IHS) Diabetes Care and Outcomes Audit. Selected measures of cardiovascular risk were aggregated by region and adjusted to calculate regional rates for patients <45 years of age (n = 2,595) and those aged > or =45 years (n = 8,294).
  
  
  RESULTS
  Among the younger group of patients with diabetes, the rates of elevated HbA(1c) (> or =9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA(1c) (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA(1c) (27%) were found in Alaska. Among patients aged > or =45 years, all measures including rates of proteinuria, cholesterol > or =200 mg/dl, and mean blood pressure > or =130/85 varied significantly among all regions. Tobacco use was highest in the Great Lakes (44%) and Great Plains (42%) regions and lowest in the Southwest (14%) and Colorado Plateau (8%) regions. Proteinuria was found most frequently in the Southwest (35%), Colorado Plateau (30%), and Pacific regions (35%). Older individuals with diabetes were more likely than younger individuals to have proteinuria and blood pressure > or =130/85.
  
  
  CONCLUSIONS
  American Indians and Alaska Natives with diabetes carry a large burden of potentially modifiable cardiovascular risk factors, but there is significant regional variation.
authors.affiliation: Bemidji Area Indian Health Service Diabetes Program, Room 115 Federal Building, 522 Minnesota Ave., Bemidji, MN 56601, USA. srithnajarian@nchs.com
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rith-Najarian
authors.forename: Dorothy M
authors.initials: DM
authors.lastname: Gohdes
authors.forename: Raymond
authors.initials: R
authors.lastname: Shields
authors.forename: Betty
authors.initials: B
authors.lastname: Skipper
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Moore
authors.forename: Bernadine
authors.initials: B
authors.lastname: Tolbert
authors.forename: Terry
authors.initials: T
authors.lastname: Raymer
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Acton
mesh_terms: D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D012307:Risk Factors; D015206:Southwestern United States / Q000453:epidemiology