title: Prevalence of and Racial Disparities in Risk Factor Control in Older Adults With Diabetes: The Atherosclerosis Risk in Communities Study.
abstract: OBJECTIVE
  Controversy surrounds appropriate risk factor targets in older adults with diabetes. We evaluated the proportion of older adults with diabetes meeting different targets, focusing on possible differences by race, and assessed whether demographic and clinical characteristics explained disparities.
  
  
  METHODS
  We conducted a cross-sectional study of 5,018 participants aged 67-90 years (1,574 with and 3,444 without diagnosed diabetes) who attended visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (2011-2013). Risk factor targets were defined using both stringent (and less stringent) goals: hemoglobin A1c (HbA1c) <7%, <53 mmol/mol (<8%, <64 mmol/mol); LDL cholesterol (LDL-c) <100 mg/dL (<130 mg/dL); and blood pressure (BP) <140/90 mmHg (<150/90 mmHg). We used Poisson regression to obtain prevalence ratios (PRs).
  
  
  RESULTS
  Most older adults with diabetes met stringent (and less stringent) targets: 72% (90%) for HbA1c, 63% (86%) for LDL-c, and 73% (87%) for BP; but only 35% (68%) met all three. A higher proportion of whites than blacks met targets, however defined. Among people treated for risk factors, racial disparities in prevalence of meeting stringent targets persisted even after adjustment: PRs (whites vs. blacks) were 1.03 (95% CI 0.91, 1.17) for HbA1c, 1.21 (1.09, 1.35) for LDL-c, 1.10 (1.00, 1.21) for BP, and 1.28 (0.99, 1.66) for all three. Results were similar but slightly attenuated using less stringent goals. Black women were less likely than white women to meet targets for BP and all three risk factors; this disparity was not observed in men.
  
  
  CONCLUSIONS
  Black-white disparities in risk factor control in older adults with diabetes were not fully explained by demographic or clinical characteristics and were greater in women than men. Further study of determinants of these disparities is important.
authors: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Christina M
authors: CM
authors: Parrinello
authors: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Baltimore Polytechnic Institute, Baltimore, MD.
authors: Ina
authors: I
authors: Rastegar
authors: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Department of Epidemiology and the Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Job G
authors: JG
authors: Godino
authors: Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN.
authors: Michael D
authors: MD
authors: Miedema
authors: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Kunihiro
authors: K
authors: Matsushita
authors: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD eselvin@jhu.edu.
authors: Elizabeth
authors: E
authors: Selvin
mesh_terms: D001741:Black or African American / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000188:drug therapy / Q000208:ethnology*; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000208:ethnology*; D004812:Epidemiologic Methods; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin