Differences in Diabetes Prevalence, Incidence, and Mortality Among the Elderly of Four Racial/Ethnic Groups: Whites, Blacks, Hispanics, and Asians

Division of Health Services Research and Policy, University of Minnesota School of Public Health, MMC 97, Mayo Memorial Building, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
Diabetes Care (Impact Factor: 8.42). 10/2004; 27(10):2317-24. DOI: 10.2337/diacare.27.10.2317
Source: PubMed


To examine diabetes prevalence, incidence, and mortality from 1993 to 2001 among fee-for-service Medicare beneficiaries > or = 67 years of age.
This study was a retrospective analysis of a 5% random sample of Medicare fee-for-service beneficiaries > or = 65 years of age in each year.
In 1993, the prevalence of diabetes among those > or = 67 years of age was 145 cases per 1,000 individuals. By 2001, it was 197/1,000, an increase of 36.0%. The 2001 prevalence among Hispanics (334/1,000) was significantly higher than among blacks (296/1,000), Asians (243/1,000), and whites (184/1,000, P < 0.0001). During the 7-year period the greatest increase in diabetes prevalence was among Asians (68.0%). Between 1994 and 2001, the annual rate of newly diagnosed elderly individuals with diabetes increased by 36.9%. Hispanics had the greatest increase at 55.0%. The mortality rate among individuals with diabetes decreased by approximately 5% between 1994 and 2001 from 92.1/1,000 to 87.2/1,000 (P < 0.001), due to a 6% decrease among whites. No decrease in mortality was seen among elderly individuals without diabetes, it was 55/1,000 in 1994 and 54/1,000 in 2001.
The dramatic increase in the incidence and prevalence of diabetes likely reflect a combination of true increases, as well as changes in the diagnostic criteria and increased interest in diagnosing and appropriately treating diabetes in the elderly. Improved treatment may have had an impact on mortality rates among individuals with diabetes, although they could have been influenced by the duration of diabetes before diagnosis, which has likely decreased. Changes in incidence, prevalence, and mortality in elderly individuals with diabetes need to continue to be monitored.

    • "However, the sample's African American racial representation (13.8 %) was higher compared to the local population (12.7 %). The percentage of Asians in the sample was low, partially due to low local representation and partially due to low rates of type 2 diabetes in Asians compared to Whites or African Americans (McBean et al., 2004). English fluently as an inclusion criterion for study participation resulted in lower reach to Latino and Hispanic individuals. "
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    ABSTRACT: Despite evidence of the benefits of physical activity, most individuals with type 2 diabetes do not meet physical activity recommendations. The purpose of this study was to test the efficacy of a brief intervention targeting self-efficacy and self-regulation to increase physical activity in older adults with type 2 diabetes. Older adults (Mage = 61.8 ± 6.4) with type 2 diabetes or metabolic syndrome were randomized into a titrated physical activity intervention (n = 58) or an online health education course (n = 58). The intervention included walking exercise and theory-based group workshops. Self-efficacy, self-regulation and physical activity were assessed at baseline, post-intervention, and a follow-up. Results indicated a group by time effect for self-regulation [F(2,88) = 14.021, p < .001, η 2 = .24] and self-efficacy [F(12,77) = 2.322, p < .05, η 2 = .266] with increases in the intervention group. The intervention resulted in short-term increases in physical activity (d = .76, p < .01), which were partially maintained at the 6-month follow-up (d = .35, p < .01). The intervention increased short-term physical activity but was not successful at maintaining increases in physical activity. Similar intervention effects were observed in self-efficacy and self-regulation. Future research warrants adjusting intervention strategies to increase long-term change.
    No preview · Article · Jul 2015 · Journal of Behavioral Medicine
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    • "This clearly indicates towards the ethnic differences in terms of lifestyle, profession and dietary pattern. Thus, ethnicity is one of the important confounding factors predisposing a population towards development of T2D supported also by earlier studies (McBean et al., 2004; Shai et al., 2006 ). The presence of caste groups has always influenced the genetic structure of Indian population making it more susceptible or protected against various diseases. "
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    ABSTRACT: To assess the effect of ethnicity, the association of WC, WHR and hypertension along with PGC-1α (Gly482Ser), UCP2 -866G/A and SIRT1-1400T/C polymorphisms in seven endogamous caste groups and pooled population of Punjab. Study was conducted on 1813 individuals (859 T2D patients and 954 healthy controls) belonging to seven endogamous groups. Waist and hip circumference, height, weight and blood pressure were recorded following standard protocol using designed performa. PGC-1α (Gly482Ser), UCP2 -866G/A polymorphisms were genotyped using PCR RFLP and SIRT1-1400T/C was genotyped by direct DNA sequencing. WHR conferred risk in Brahmins (p=0.00003), Khtaris (p=0.001) and SCs (p=0.02). Similarly, we detected WC conferred risk in BCs (p=0.012), Brahmins (p=0.016), Jat Sikhs (0.00025), Khatris (0.005) and SCs (p=0.015). In pooled population, WHR (p=0.00001), hypertension (p=0.003) and WC (p=0.0000016), all three factors imparted risk. With respect to gene polymorphism, PGC-1α (Gly482Ser) was associated in Banias (p=0.0003), Jat Sikhs (p=0.003) and Khatris [p=0.03, OR- 1.51 (1.02- 2.27)]. Simlarly, UCP2 -866G>A showed risk in Banias (p=0.000004), BCs (p=0.01) and SCs (p=0.01). However, SIRT1 -1400T>C showed risk only in Khatris (p=0.004). In pooled population of Punjab, both PGC-1α (Gly482Ser) [p=0.001] and UCP2 -866G>A (p=0.0001) polymorphisms provided risk. Interaction analysis showed 72% of the patients had risk combination of PGC-1α XA and UCP2 -866 XA genotypes. Based on the data, Khatris were found to be showing the highest susceptibility to T2D followed by SCs. Different combination of factors provided risk in each caste group and in pooled population. Therefore, to curve the menace of T2D, detailed information about the ethnic background of the individual will be very useful for proper medical intervention. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Mar 2015 · Gene
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    • "Studies in the U.S. have shown African American and Hispanic populations to have rates of cardiovascular complications similar to or lower than those of Europeans (5,6). Mortality rates are decreased for Hispanic populations with diabetes and increased for African Americans (7,8). Data are limited in other ethnic groups, however, and also from other countries where universal health care systems may mitigate some barriers to care for minority patients. "
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    ABSTRACT: OBJECTIVE Many non-European ethnic groups have an increased risk for diabetes; however, the published literature demonstrates considerable uncertainty about the rates of diabetes complications among minority populations. The objective of this study was to determine the risks of cardiovascular complications and of mortality after diabetes diagnosis for South Asian and Chinese patients, compared with European patients.RESEARCH DESIGN AND METHODSA population-based cohort study identified all 491,243 adults with newly diagnosed diabetes in Ontario, Canada, between April 2002 and March 2009. Subjects were followed until March 2011 for the first occurrence of any cardiovascular complication of diabetes (coronary artery disease, stroke, or lower-extremity amputation) and for all-cause mortality. Median follow-up was 4.7 years.RESULTSThe crude incidence of cardiovascular complications after diabetes diagnosis was 17.9 per 1,000 patient-years among European patients, 12.0 among South Asian patients, and 7.7 among Chinese patients. After adjusting for baseline characteristics, the cause-specific hazard ratios (HRs) for cardiovascular complications relative to European patients were 0.95 (95% CI 0.90-1.00; P = 0.056) and 0.50 (0.46-0.53; P < 0.001) for South Asian and Chinese patients, respectively. Mortality was lower for both minority groups (adjusted HR for South Asian patients 0.56 [95% CI 0.52-0.60]; P < 0.001; for Chinese patients 0.58 [0.55-0.62]; P < 0.001).CONCLUSIONS Chinese patients were at substantially lower risk than European patients for cardiovascular complications after diabetes diagnosis, whereas South Asian patients were at comparable risk. Mortality after diabetes diagnosis was markedly lower for both minority populations.
    Full-text · Article · May 2013 · Diabetes care
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