title: The effects of race and region on cardiovascular morbidity among elderly Americans with diabetes.
abstract: OBJECTIVE
  There is conflicting evidence about whether nonwhite Americans with diabetes have an increased risk of cardiovascular disease (CVD). Because geographic region is known to influence the risk of CVD in the U.S., we sought to determine the effects of race and region on cardiovascular morbidity among elderly Americans with diabetes.
  
  
  METHODS
  We performed a national, retrospective, cohort study using the Medicare claims of 126,153 white and 17,962 black patients with diabetes, aged > or =65 years in 1994, who were followed through 1999 for incident acute myocardial infarction, ischemic heart disease, stroke, and heart failure. The effect of race, sex, and region on the incidence of these diseases was assessed using Cox proportional hazards regression, adjusting for baseline demographics and comorbidities.
  
  
  RESULTS
  The incidence of any CVD ranged from 23.9/100 person-years among southern black men to 29.2/100 person-years among non-southern black women. The risk of CVD was lower among southern black men (hazard ratio 0.87 [95% CI 0.82-0.92]) and women (0.95 [0.91-0.99]) than their southern white counterparts. In the three other U.S. regions combined (northeast, midwest, and west), black men had a similar risk for CVD (1.01 [0.95-1.07]), and black women had a greater risk (1.10 [1.05-1.16]) than non-southern white men and women, respectively.
  
  
  CONCLUSIONS
  Among elderly Americans with diabetes, the incidence of CVD is unlikely to differ a great deal between whites and blacks. Residence in the South seems to confer a modest benefit for elderly black people with diabetes.
authors.affiliation: Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA. abertoni@wfubmc.edu
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: Julienne K
authors.initials: JK
authors.lastname: Kirk
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.forename: Christine
authors.initials: C
authors.lastname: Kay
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology / Q000208:ethnology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data