title: Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study.
abstract: To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study.
  
  
  
  We conducted a prospective cohort study of 706 participants (aged 15-81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria.
  
  
  
  Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5-14.7) for all-cause mortality and 5.6 (95% CI 2.1-15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7-32.1) and 3.9 (95% CI 1.4-10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively.
  
  
  
  In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes.
authors.affiliation: Menzies School of Health Research, Darwin, Australia.|Baker Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: E L M
authors.identifier: 0000-0003-4284-1716
authors.initials: ELM
authors.lastname: Barr
authors.affiliation: Menzies School of Health Research, Darwin, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Cunningham
authors.affiliation: Menzies School of Health Research, Darwin, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Tatipata
authors.affiliation: Charles Darwin University, Darwin, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Dunbar
authors.affiliation: Royal Darwin Hospital, Darwin, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Kangaharan
authors.affiliation: Menzies School of Health Research, Darwin, Australia.|Health Gains Planning, Northern Territory Department of Health, Darwin, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Guthridge
authors.affiliation: Health Gains Planning, Northern Territory Department of Health, Darwin, Australia.
authors.forename: S Q
authors.initials: SQ
authors.lastname: Li
authors.affiliation: Menzies School of Health Research, Darwin, Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Condon
authors.affiliation: Baker Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: University of South Australia, Adelaide, Australia.|University of Melbourne, Melbourne, Australia.
authors.forename: K
authors.initials: K
authors.lastname: O'Dea
authors.affiliation: Menzies School of Health Research, Darwin, Australia.|Royal Darwin Hospital, Darwin, Australia.
authors.forename: L J
authors.initials: LJ
authors.lastname: Maple-Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000208:ethnology / Q000209:etiology; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D058065:Diabetic Cardiomyopathies / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D003928:Diabetic Nephropathies / Q000150:complications* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D014504:Urban Health / Q000208:ethnology