Ethnic disparities in diabetic complications in an insured population.
BACKGROUND
Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health care coverage may be useful.


OBJECTIVE
To assess ethnic disparities in the incidence of diabetic complications within a nonprofit prepaid health care organization.


METHODS
Longitudinal observational study conducted January 1, 1995, through December 31, 1998, at Kaiser Permanente Medical Care Program in northern California.


METHODS
A total of 62 432 diabetic patients, including Asians (12%), blacks (14%), Latinos (10%), and whites (64%).


METHODS
Incident myocardial infarction (MI), stroke, congestive heart failure (CHF), and nontraumatic lower extremity amputation (LEA), defined by primary hospitalization discharge diagnosis, procedures, or underlying cause of death; and end-stage renal disease (ESRD), defined as renal insufficiency requiring renal replacement therapy or transplantation for survival or by underlying cause of death.


RESULTS
Patterns of ethnic differences were not consistent across complications and frequently persisted despite adjustment for a wide range of demographic, socioeconomic, behavioral, and clinical factors. Adjusted hazard ratios (relative to that of whites) were 0.56, 0.68, and 0.68 for blacks, Asians, and Latinos, respectively (P<.001), for MI; 0.76 and 0.72 for Asians and Latinos, respectively (P<.01), for stroke; 0.70 and 0.61 for Asians and Latinos, respectively (P<.01), for CHF; 0.40 for Asians (P<.001) for LEA; and 2.03, 1.85, and 1.46 for blacks, Asians, and Latinos, respectively (P<.01), for ESRD. There were no statistically significant black-white differences for stroke, CHF, or LEA and no Latino-white differences for LEA.


CONCLUSIONS
This study confirms previous reports of elevated incidence of ESRD among ethnic minorities, despite uniform medical care coverage, and provides new evidence that rates of other complications are similar or lower relative to those of whites. The persistence of ethnic disparities after adjustment suggests a possible genetic origin, the contribution of unmeasured environmental factors, or a combination of these factors.
Karter
Andrew J
AJ
Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA. Andy.J.Karter@kp.org
Ferrara
Assiamira
A
Liu
Jennifer Y
JY
Moffet
Howard H
HH
Ackerson
Lynn M
LM
Selby
Joe V
JV
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000208:ethnology; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000208:ethnology; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology; D014481:United States / Q000453:epidemiology