medwireNews: Findings from the CARDIA study support the contention that modifiable risk factors account for the excess type 2 diabetes risk in Black versus White people during middle-age.
During an average follow-up of 24.5 years, there were 315 new cases of diabetes among 2066 Black participants and 189 among 2185 White people, giving diabetes incidence rates of 152 versus 86 per 1000 people. After accounting for age, sex, and study center, this equated to an excess risk among Black people of 67 cases per 1000 people.
In line with previous reports, the risk difference between Black and White participants for diabetes was more marked in women than men, with hazard ratios of 2.86 and 1.67, respectively.
As reported in JAMA, adjusting for risk factors during follow-up completely eliminated this racial risk difference, with biologic factors such as fasting glucose, BMI, waist circumference, parental diabetes, and cholesterol levels having the greatest impact.
In fact, accounting for biologic factors alone entirely eliminated the diabetes racial disparity, although socioeconomic and behavioral factors, considered separately, also had substantial effects, with socioeconomic factors reducing the racial disparity among men to nonsignificance. Neighborhood and psychosocial factors had only small effects.
Accounting for risk factors at the baseline average age of 25 years also reduced the racial disparity in diabetes risk, although to a lesser extent than adjusting for risk factors over time. When considered in isolation, biologic factors again had the most powerful effects in women, but for men socioeconomic factors played the largest role.
Researcher Michael Bancks (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) and team say their findings support previous research showing that environmental determinants of behavior and access to healthcare may directly affect biologic factors that themselves influence diabetes risk.
“These results suggest prevention efforts that address racial inequalities in socioeconomic factors (eg, educational attainment and income) may be one strategy to reduce racial disparities in diabetes risk,” they conclude.
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