title: Diabetes incidence based on linkages with health plans: the multiethnic cohort.
abstract: OBJECTIVE
  Using the Hawaii component of the Multiethnic Cohort (MEC), we estimated diabetes incidence among Caucasians, Japanese Americans, and Native Hawaiians.
  
  
  METHODS
  After excluding subjects who reported diabetes at baseline or had missing values, 93,860 cohort members were part of this analysis. New case subjects were identified through a follow-up questionnaire (1999-2000), a medication questionnaire (2003-2006), and linkage with two major health plans (2007). We computed age-standardized incidence rates and estimated hazard ratios (HRs) for ethnicity, BMI, education, and combined effects of these variables using Cox regression analysis.
  
  
  RESULTS
  After a total follow-up time of 1,119,224 person-years, 11,838 incident diabetic case subjects were identified with an annual incidence rate of 10.4 per 1,000 person-years. Native Hawaiians had the highest rate with 15.5, followed by Japanese Americans with 12.5, and Caucasians with 5.8 per 1,000 person-years; the adjusted HRs were 2.65 for Japanese Americans and 1.93 for Native Hawaiians. BMI was positively related to incidence in all ethnic groups. Compared with the lowest category, the respective HRs for BMIs of 22.0-24.9, 25.0-29.9, and > or =30.0 kg/m(2) were 2.10, 4.12, and 9.48. However, the risk was highest for Japanese Americans and intermediate for Native Hawaiians in each BMI category. Educational achievement showed an inverse association with diabetes risk, but the protective effect was limited to Caucasians.
  
  
  CONCLUSIONS
  Within this multiethnic population, diabetes incidence was twofold higher in Japanese Americans and Native Hawaiians than in Caucasians. The significant interaction of ethnicity with BMI and education suggests ethnic differences in diabetes etiology.
authors.affiliation: Cancer Research Center, University of Hawaii, Honolulu, Hawaii, USA. gertraud@crch.hawaii.edu
authors.forename: Gertraud
authors.initials: G
authors.lastname: Maskarinec
authors.forename: Eva
authors.initials: E
authors.lastname: Erber
authors.forename: Andrew
authors.initials: A
authors.lastname: Grandinetti
authors.forename: Martijn
authors.initials: M
authors.lastname: Verheus
authors.forename: Robert
authors.initials: R
authors.lastname: Oum
authors.forename: Beth N
authors.initials: BN
authors.lastname: Hopping
authors.forename: Mark M
authors.initials: MM
authors.lastname: Schmidt
authors.forename: Aileen
authors.initials: A
authors.lastname: Uchida
authors.forename: Deborah Taira
authors.initials: DT
authors.lastname: Juarez
authors.forename: Krista
authors.initials: K
authors.lastname: Hodges
authors.forename: Laurence N
authors.initials: LN
authors.lastname: Kolonel
mesh_terms: D001213:Asian; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008019:Life Style; D008297:Male; D044468:Native Hawaiian or Pacific Islander; D015995:Prevalence; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires