title: Mortality by race among low-income adults with early-onset insulin-treated diabetes.
abstract: OBJECTIVE
  To determine if long-term mortality rates in early-onset insulin-treated diabetes differ by race among adults of similar socioeconomic status.
  
  
  METHODS
  A total of 391 (299 African Americans, 92 whites) mostly low-income adults 40-79 years of age with insulin-treated diabetes diagnosed before 30 years of age were recruited from community health centers in the southeast U.S. Cox models were used to estimate hazard ratios (HRs) of all-cause mortality among African Americans compared with whites. Additionally, standardized mortality ratios (SMRs) were used to compare the mortality experience of the individuals with diabetes with both national and general community health center sex- and race-specific population norms.
  
  
  RESULTS
  Mean age at diabetes diagnosis and cohort entry, respectively, was 21 and 50 years in African Americans and 19 and 51 years in whites. During an average of 6.7 years of follow-up, 29% of African Americans and 35% of whites died. In multivariable analysis, no significant mortality difference was observed among African Americans compared with whites (HR 0.83 [95% CI 0.53-1.30]; P=0.51). Compared with the race-specific U.S. general population, SMRs for those with diabetes were 5.7 in African Americans and 11.7 in whites. However, when compared with the same source population (i.e., the community health center population), SMRs were 3.5 and 3.7 in African Americans and whites, respectively.
  
  
  CONCLUSIONS
  Elevated mortality persists in men and women with long duration of early-onset insulin-treated diabetes, but given survival to 40 years of age and similarly low economic status and access to health care, our data do not suggest a racial disparity in mortality.
authors.affiliation: Corresponding author: Baqiyyah Nilija Conway, bnconway@hsc.wvu.edu.
authors.forename: Baqiyyah Nilija
authors.initials: BN
authors.lastname: Conway
authors.forename: Thomas Anais
authors.initials: TA
authors.lastname: Elasy
authors.forename: Michael E
authors.initials: ME
authors.lastname: May
authors.forename: William James
authors.initials: WJ
authors.lastname: Blot
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D007328:Insulin