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Diabetes Outcomes in Asian Americans

Diabetes Outcomes in Asian Americans. Alka Kanaya, MD Associate Professor of Medicine, UCSF September 30, 2011. Diabetes Complications. Ethnic minority groups (African Americans and Latinos) have higher risk ESRD but lower CVD risk compared to Whites

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Diabetes Outcomes in Asian Americans

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  1. Diabetes Outcomes in Asian Americans Alka Kanaya, MD Associate Professor of Medicine, UCSF September 30, 2011

  2. Diabetes Complications

  3. Ethnic minority groups (African Americans and Latinos) have higher risk ESRD but lower CVD risk compared to Whites • “Asians” and Pacific Islanders have been aggregated to show similar findings: • Lower incidence of CVD and LEA • Higher incidence of ESRD Karter, Jama, 2002

  4. Rosenberg, Plos Genetics, 2006

  5. Diabetes Care, 2011

  6. Disaggregating Asian subgroups • We analyzed Kaiser data (DISTANCE) • 10 year follow-up (1996-2006) • Mean follow-up of 7.2 ± 3.3 years • N=64,211 with diabetes • Complications: (incidence of…) • MI • CHF • Stroke • ESRD • Lower extremity amputations (LEA)

  7. White: 40,286 Black: 8,668 Latino: 7,763 “Asian”: 6,901 Filipino: 3,572 Chinese: 1,823 Japanese: 951 South Asians: 555 Pacific Islanders: 593 TOTAL: 64,211 Kaiser diabetes participants

  8. Demographic and SES

  9. BMI and Behavioral Data

  10. Clinical Data

  11. Results • Age- and sex-adjusted incidence rates • Fully adjusted hazards ratios (95% CI) compared to Whites

  12. MI incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. PI SA

  13. MI incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. SA PI

  14. CHF incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. SA PI

  15. Stroke/TIA incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. SA PI

  16. ESRD incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. SA PI

  17. LEA incidence Incidence rate per 1,000 py White Black Lat AAPI Filip. Chin. Jap. SA PI

  18. Sequential adjustments • Sex and age-adjusted • + SES variables: education, English language proficiency, neighborhood deprivation score • + BMI • + Behavioral variables: smoking, alcohol use, exercise, medication adherence • + Disease variables: type and duration of diabetes, HbA1c, hypertension, eGFR, albuminuria, and LDL-cholesterol

  19. Fully-adjusted model African American Latino All AAPI Chinese Japanese Filipino Pacific Islander South Asian MI outcome Compared to Whites… Age and sex-adjusted only

  20. Congestive Heart Failure African American Latino All AAPI Chinese Japanese Filipino Pacific Islander South Asian

  21. Stroke/TIA African American Latino All AAPI Chinese Japanese Filipino Pacific Islander South Asian

  22. ESRD African American Latino All AAPI Chinese Japanese Filipino Pacific Islander South Asian

  23. Lower extremity amputation African American Latino All AAPI Chinese Japanese Filipino Pacific Islander South Asian

  24. Sex interaction: MI only

  25. Other studies: CVD outcomes • Hawaii: NHOPI had higher cardiometabolic risk compared to other US ethnicities • New Zealand: PI had higher CVD risk factors and CVD risk than Europeans • UKPDS: SA had similar risk of CVD to Europeans • Singapore: SA had higher CVD risk compared to Chinese and Malay

  26. Other studies: ESRD outcome • Hawaii: KEEP-2 study • DM was a stronger risk factor for CKD in native Hawaiian, Chinese, and Filipino than in Japanese or Whites • U.K. and Netherlands studies: • South Asians have higher diabetic ESRD risk than Europeans

  27. Limitations • Other explanatory variables? • Stress, “acculturation”, dietary intake, second hand smoke, attitudes about disease prevention… • Misclassification of outcomes • Should not vary by ethnic group • Prior medical record validations show high reliability • Small numbers in some Asian strata

  28. Conclusions of Kaiser study • In a setting with uniform access to health care, tremendous heterogeneity among Asian subgroups for most outcomes. • MI: Pacific Islander women at highest MI risk • CHF and CVA: Lower risk in most ethnic groups except AA, Pacific Islanders, and South Asians • ESRD: higher risk for all ethnic groups (NS-SA) • LEA: dramatically lower risk in all Asian groups (NS-PI) • These differences were not explained by traditional, socioeconomic, and behavioral risk factors. • Possible biologic/genetic or unmeasured environmental differences between ethnic groups.

  29. The DISTANCE study was supported by RO1-DK-065664, R01-DK-081796 and R01-HD-46113

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