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

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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.

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Acknowledgment

This study represents work supported by the use of resources at the VA HSR&D Funded Center for Disease Prevention and Health Interventions for Diverse Populations (REA 08-261) in Charleston, SC.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA

    Cheryl P. Lynch MD, MPH, Mulugeta Gebregziabher PhD, Carrae Echols MS, Gregory E. Gilbert MSPH & Leonard E. Egede MD, MS

  2. Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA

    Cheryl P. Lynch MD, MPH, Yumin Zhao MS & Leonard E. Egede MD, MS

  3. Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Mulugeta Gebregziabher PhD

  4. Center for Disease Prevention and Health Interventions for Diverse Populations and Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, P.O. Box 250593, Charleston, SC, 29425-0593, USA

    Leonard E. Egede MD, MS

Authors
  1. Cheryl P. Lynch MD, MPH
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  2. Mulugeta Gebregziabher PhD
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  3. Carrae Echols MS
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  4. Gregory E. Gilbert MSPH
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  5. Yumin Zhao MS
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  6. Leonard E. Egede MD, MS
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Corresponding author

Correspondence to Leonard E. Egede MD, MS.

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Lynch, C.P., Gebregziabher, M., Echols, C. et al. Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes. J GEN INTERN MED 25, 1051–1056 (2010). https://doi.org/10.1007/s11606-010-1405-y

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  • DOI: https://doi.org/10.1007/s11606-010-1405-y

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