Racial disparities in trends for cardiovascular disease and procedures among hospitalized diabetic patients.
METHODS
To determine if racial differences exist for trends in diabetes-related cardiovascular disease (CVD) hospitalization rates, we analyzed data from an inpatient hospital discharge database maintained by the South Carolina Office of Research and Statistics. All hospitalizations involving a diagnosis of diabetes were collected from 1996 through 2003. International Classification of Diseases codes were used to determine diagnosis for diabetes, acute myocardial infraction (AMI), stroke, and other CVD outcomes. Multiple linear regression was performed to model the age-standardized rates during the study period. An interaction parameter for race and discharge year was used in the models to determine if the trend slopes varied between African Americans and Caucasians.


RESULTS
The diabetes-related hospitalization rates for AMI and stroke declined for both race groups. Although the stroke rates for African Americans were consistently higher than those for Caucasians, the African American trend declined more sharply (P=.027). AMI rates showed sharper declines among Caucasians (P<.001). Rates of CVD procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass graft) were two to three times greater among Caucasians. Cardiomyopathy rates were significantly greater among African Americans and showed a larger increasing trend (P<.001), and findings for congestive heart failure trends were similar (P<.001).


CONCLUSIONS
Diabetes-related CVD rates and trends vary considerably by race. Rates of AMI and stroke declined in African Americans and Caucasians from 1996 through 2003, while other CVD rates increased. Further research is needed to understand the underlying components of these disparities.
Mountford
William K
WK
Department of Biostatistics, Bioinformatics, Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA. mountfo@musc.edu
Lackland
Daniel T
DT
Soule
Jeremy B
JB
Hunt
Kelly J
KJ
Lipsitz
Stuart R
SR
Colwell
John A
JA
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000208:ethnology* / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data; D016208:Databases, Factual; D048909:Diabetes Complications / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D013022:South Carolina / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*