Non-traditional risk factors are important contributors to the racial disparity in diabetes risk: the atherosclerosis risk in communities study.
BACKGROUND
Traditional risk factors, particularly obesity, do not completely explain the excess risk of diabetes among African Americans compared to whites.


OBJECTIVE
We sought to quantify the impact of recently identified, non-traditional risk factors on the racial disparity in diabetes risk.


METHODS
Prospective cohort study.


METHODS
We analyzed data from 2,322 African-American and 8,840 white participants without diabetes at baseline from the Atherosclerosis Risk in Communities (ARIC) Study.


METHODS
We used Cox regression to quantify the association of incident diabetes by race over 9 years of in-person and 17 years of telephone follow-up, adjusting for traditional and non-traditional risk factors based on literature search. We calculated the mediation effect of a covariate as the percent change in the coefficient of race in multivariate models without and with the covariate of interest; 95 % confidence intervals (95 % CI) were calculated using boot-strapping.


RESULTS
African American race was independently associated with incident diabetes. Body mass index (BMI), forced vital capacity (FVC), systolic blood pressure, and serum potassium had the greatest explanatory effects for the difference in diabetes risk between races, with mediation effects (95 % CI) of 22.0 % (11.7 %, 42.2 %), 21.7 %(9.5 %, 43.1 %), 17.9 % (10.2 %, 37.4 %) and 17.7 % (8.2 %, 39.4 %), respectively, during 9 years of in-person follow-up, with continued effect over 17 years of telephone follow-up.


CONCLUSIONS
Non-traditional risk factors, particularly FVC and serum potassium, are potential mediators of the association between race and diabetes risk. They should be studied further to verify their importance and to determine if they mark causal relationships that can be addressed to reduce the racial disparity in diabetes risk.
Department of Medicine, Duke University, Durham, NC, USA, ranee.chatterjee@duke.edu.
Ranee
R
Chatterjee
Frederick L
FL
Brancati
Tariq
T
Shafi
David
D
Edelman
James S
JS
Pankow
Thomas H
TH
Mosley
Elizabeth
E
Selvin
Hsin Chieh
HC
Yeh
D001741:Black or African American / Q000208:ethnology*; D050197:Atherosclerosis / Q000208:ethnology* / Q000209:etiology* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D048909:Diabetes Complications / Q000208:ethnology* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D014797:Vital Capacity / Q000502:physiology; D044465:White People / Q000208:ethnology*
D015415:Biomarkers; D011188:Potassium