title: Ethnic disparities in risk of cardiovascular disease, end-stage renal disease and all-cause mortality: a prospective study among Asian people with Type 2 diabetes.
abstract: OBJECTIVE
  To study prospectively the ethnic-specific risks of cardiovascular disease, end-stage renal disease and all-cause mortality in patients with Type 2 diabetes mellitus among native Asian subpopulations.
  
  
  METHODS
  A total of 2337 subjects with Type 2 diabetes (70% Chinese, 17% Malay and 13% Asian Indian) were followed for a median of 4.0 years. Time-to-event analysis was used to study the association of ethnicity with adverse outcomes.
  
  
  RESULTS
  Age- and gender-adjusted hazard ratios for cardiovascular disease in ethnic Malay and Asian Indian subjects were 2.01 (1.40-2.88; P<0.0001) and 1.60 (1.07-2.41; P=0.022) as compared with Chinese subjects. Adjustment for conventional cardiovascular disease risk factors, including HbA1c , blood pressure and lipid profile, slightly attenuated the hazards in Malay (1.82, 1.23-2.71; P=0.003) and Asian Indian subjects (1.47, 0.95-2.30; P=0.086); However, further adjustment for baseline renal function (estimated GFR) and albuminuria weakened the cardiovascular disease risks in Malay (1.48, 0.98-2.26; P=0.065) but strengthened that in Asian Indian subjects (1.81, 1.14-2.87; P=0.012). Competing-risk regression showed that the age- and gender-adjusted sub-distribution hazard ratio for end-stage renal disease was 1.87 (1.27-2.73; P=0.001) in Malay and 0.39 (0.18-0.83; P=0.015) in Asian Indian subjects. Notably, the difference in end-stage renal disease risk among the three ethnic groups was abolished after further adjustment for baseline estimated GFR and albuminuria. There was no significant difference in risk of all-cause mortality among the three ethnic groups.
  
  
  CONCLUSIONS
  Risks of cardiovascular and end-stage renal diseases in native Asian subjects with Type 2 diabetes vary substantially among different ethnic groups. Differences in prevalence of diabetic kidney disease may partially explain the ethnic disparities.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
authors.forename: J J
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.|Department of Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: S C
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: L Y
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Su
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: B C
authors.initials: BC
authors.lastname: Tai
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Low
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Fun
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.|Department of Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: K S
authors.initials: KS
authors.lastname: Chia
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: E S
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.|Department of Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: C F
authors.initials: CF
authors.lastname: Sum
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology* / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000150:complications / Q000208:ethnology / Q000401:mortality; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors