Journal of General Internal Medicine

, Volume 29, Issue 2, pp 290–297

Non-Traditional Risk Factors are Important Contributors to the Racial Disparity in Diabetes Risk: The Atherosclerosis Risk in Communities Study

Authors

    • Department of MedicineDuke University
  • Frederick L. Brancati
    • Department of MedicineJohns Hopkins University
    • Department of EpidemiologyJohns Hopkins University
  • Tariq Shafi
    • Department of MedicineJohns Hopkins University
  • David Edelman
    • Department of MedicineDuke University
  • James S. Pankow
    • Division of Epidemiology and Community Health, School of Public HealthUniversity of Minnesota
  • Thomas H. Mosley
    • Department of Medicine (Geriatrics)University of Mississippi Medical Center
  • Elizabeth Selvin
    • Department of MedicineJohns Hopkins University
    • Department of EpidemiologyJohns Hopkins University
  • Hsin Chieh Yeh
    • Department of MedicineJohns Hopkins University
    • Department of EpidemiologyJohns Hopkins University
Original Research

DOI: 10.1007/s11606-013-2569-z

Cite this article as:
Chatterjee, R., Brancati, F.L., Shafi, T. et al. J GEN INTERN MED (2014) 29: 290. doi:10.1007/s11606-013-2569-z

ABSTRACT

BACKGROUND

Traditional risk factors, particularly obesity, do not completely explain the excess risk of diabetes among African Americans compared to whites.

OBJECTIVE

We sought to quantify the impact of recently identified, non-traditional risk factors on the racial disparity in diabetes risk.

DESIGN

Prospective cohort study.

PARTICIPANTS

We analyzed data from 2,322 African-American and 8,840 white participants without diabetes at baseline from the Atherosclerosis Risk in Communities (ARIC) Study.

MAIN MEASURES

We used Cox regression to quantify the association of incident diabetes by race over 9 years of in-person and 17 years of telephone follow-up, adjusting for traditional and non-traditional risk factors based on literature search. We calculated the mediation effect of a covariate as the percent change in the coefficient of race in multivariate models without and with the covariate of interest; 95 % confidence intervals (95 % CI) were calculated using boot-strapping.

KEY RESULTS

African American race was independently associated with incident diabetes. Body mass index (BMI), forced vital capacity (FVC), systolic blood pressure, and serum potassium had the greatest explanatory effects for the difference in diabetes risk between races, with mediation effects (95 % CI) of 22.0 % (11.7 %, 42.2 %), 21.7 %(9.5 %, 43.1 %), 17.9 % (10.2 %, 37.4 %) and 17.7 % (8.2 %, 39.4 %), respectively, during 9 years of in-person follow-up, with continued effect over 17 years of telephone follow-up.

CONCLUSIONS

Non-traditional risk factors, particularly FVC and serum potassium, are potential mediators of the association between race and diabetes risk. They should be studied further to verify their importance and to determine if they mark causal relationships that can be addressed to reduce the racial disparity in diabetes risk.

KEY WORDS

non-traditional risk factorsdiabetesracial disparity

Copyright information

© Society of General Internal Medicine 2013