title: Racial and ethnic differences in microalbuminuria prevalence in a diabetes population: the pathways study.
abstract: The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. youngb@u.washington.edu
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Greg E
authors.initials: GE
authors.lastname: Simon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ciechanowski
authors.forename: Terry
authors.initials: T
authors.lastname: Bush
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000208:ethnology*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D015228:Hypertriglyceridemia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors