Journal of General Internal Medicine

, Volume 25, Issue 10, pp 1051–1056

Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

  • Cheryl P. Lynch
  • Mulugeta Gebregziabher
  • Carrae Echols
  • Gregory E. Gilbert
  • Yumin Zhao
  • Leonard E. Egede
Original Research

DOI: 10.1007/s11606-010-1405-y

Cite this article as:
Lynch, C.P., Gebregziabher, M., Echols, C. et al. J GEN INTERN MED (2010) 25: 1051. doi:10.1007/s11606-010-1405-y

Abstract

BACKGROUND

Racial differences in mortality among veterans with diabetes are less well characterized than those in the general population.

OBJECTIVE

To examine racial differences in all-cause mortality in a large sample of veterans with diabetes.

DESIGN

A retrospective cohort.

PARTICIPANTS

Participants comprised 8,812 veterans with type 2 diabetes.

MEASUREMENTS

The main outcome measure was time to death. The main predictor was race/ethnicity. Other risk factors (or covariates) included age, gender, marital status, employment, glycosylated hemoglobin (HgbA1c), and several ICD-9 coded physical and mental health comorbidities.

RESULTS

Average follow-up was 4.5 years; 64% of veterans were non-Hispanic whites (NHW), 97% male, and 84% at least 50 years old. The overall mortality rate was 15% and was significantly lower for non-Hispanic blacks (NHB). Baseline HgbA1c values also differed for NHW (mean = 7.05) and NHB (mean = 7.65) (p < 0.001). In sequentially-built models NHB race was associated with a lower risk of mortality with HR ranging 0.80-0.92. After adjusting for all significant covariates, the risk of mortality remained lower for NHB (HR = 0.84, 95% CI: 0.75, 0.94). Increased mortality risk was associated with age, not being employed or retired, poor glycemic control, cancer, Coronary Heart Disease (CHD), and anxiety disorder; while a lower risk was associated with being female and ever being married.

CONCLUSIONS

The risk of death among NHB veterans with diabetes remained significantly lower than that of NHW after controlling for important confounding variables. Future studies in the VA need to examine detailed contributions of patient, provider and system-level factors on racial differences in mortality in adults with diabetes, especially if the findings of this study are replicated at other sites or using national VA data.

KEY WORDS

raceall-cause mortalitydiabetesveterans

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Cheryl P. Lynch
    • 1
    • 2
  • Mulugeta Gebregziabher
    • 1
    • 3
  • Carrae Echols
    • 1
  • Gregory E. Gilbert
    • 1
  • Yumin Zhao
    • 2
  • Leonard E. Egede
    • 1
    • 2
    • 4
  1. 1.Center for Disease Prevention and Health Interventions for Diverse PopulationsRalph H. Johnson Veterans Affairs Medical CenterCharlestonUSA
  2. 2.Center for Health Disparities Research, Division of General Internal MedicineMedical University of South CarolinaCharlestonUSA
  3. 3.Division of Biostatistics & EpidemiologyMedical University of South CarolinaCharlestonUSA
  4. 4.Center for Disease Prevention and Health Interventions for Diverse Populations and Center for Health Disparities ResearchMedical University of South CarolinaCharlestonUSA