CV and Cancer Mortality in Women With and Without Diabetes
CV and Cancer Mortality in Women With and Without Diabetes
Using data from the Women's Health Initiative (1993–2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2–3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.
Diabetes is the seventh leading cause of death in the United States. By 2030, an estimated 48 million people older than 64 years of age in developed countries will be living with diabetes. Cardiovascular disease (CVD) plays a significant role in the rate of death from diabetes; adults with diabetes are 2–4 times more likely to die of CVD than are those without diabetes. Vascular disease is responsible for the vast majority of diabetes-related deaths in North America and Europe. Women with diabetes are at a higher risk of CVD and experience more adverse outcomes after a vascular event than do women without diabetes. Additionally, the increased mortality risk after a myocardial infarction that is associated with diabetes is higher in women than in men with diabetes.
In addition to sex, differences in diabetes mortality rates may exist for racial and ethnic groups. Among people with diabetes in the United States, blacks and Hispanics are 2.1 times and 1.5 times more likely than whites to die of all causes, respectively, whereas total mortality among Asians is considerably lower compared with that among whites. Death from myocardial infarction has been reported to be significantly lower in blacks with diabetes than in whites.
Diabetes and its precursor, the metabolic syndrome, are becoming established as causes of cancers of various anatomic sites, with the strongest evidence for lung cancer, colon cancer, and breast cancer. There is evidence suggesting an elevated risk of colon cancer in blacks with diabetes compared with whites with diabetes.
To our knowledge, there has been no study that has examined racial/ethnic disparities in mortality outcomes among postmenopausal women with and without diabetes. Data from the Women's Health Initiative (WHI) provide a unique opportunity to examine racial/ethnic disparities on rates of overall, CVD, and cancer mortality among postmenopausal women with and without diabetes. We hypothesized that overall mortality, CVD mortality, and cancer mortality rates will differ by race/ethnicity.
Abstract and Introduction
Abstract
Using data from the Women's Health Initiative (1993–2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2–3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.
Introduction
Diabetes is the seventh leading cause of death in the United States. By 2030, an estimated 48 million people older than 64 years of age in developed countries will be living with diabetes. Cardiovascular disease (CVD) plays a significant role in the rate of death from diabetes; adults with diabetes are 2–4 times more likely to die of CVD than are those without diabetes. Vascular disease is responsible for the vast majority of diabetes-related deaths in North America and Europe. Women with diabetes are at a higher risk of CVD and experience more adverse outcomes after a vascular event than do women without diabetes. Additionally, the increased mortality risk after a myocardial infarction that is associated with diabetes is higher in women than in men with diabetes.
In addition to sex, differences in diabetes mortality rates may exist for racial and ethnic groups. Among people with diabetes in the United States, blacks and Hispanics are 2.1 times and 1.5 times more likely than whites to die of all causes, respectively, whereas total mortality among Asians is considerably lower compared with that among whites. Death from myocardial infarction has been reported to be significantly lower in blacks with diabetes than in whites.
Diabetes and its precursor, the metabolic syndrome, are becoming established as causes of cancers of various anatomic sites, with the strongest evidence for lung cancer, colon cancer, and breast cancer. There is evidence suggesting an elevated risk of colon cancer in blacks with diabetes compared with whites with diabetes.
To our knowledge, there has been no study that has examined racial/ethnic disparities in mortality outcomes among postmenopausal women with and without diabetes. Data from the Women's Health Initiative (WHI) provide a unique opportunity to examine racial/ethnic disparities on rates of overall, CVD, and cancer mortality among postmenopausal women with and without diabetes. We hypothesized that overall mortality, CVD mortality, and cancer mortality rates will differ by race/ethnicity.
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