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Racial Differences in Health Outcomes for Adults with Diabetes in a Military Setting

Racial Differences in Health Outcomes for Adults with Diabetes in a Military Setting. Telita Crosland, MD, MPH Madigan Army Medical Center. Introduction. Diabetes affects approximately 18.2 million Sixth leading cause of death Direct care is in excess of $90 billion dollars. Introduction.

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Racial Differences in Health Outcomes for Adults with Diabetes in a Military Setting

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  1. Racial Differences in Health Outcomes for Adults with Diabetes in a Military Setting Telita Crosland, MD, MPH Madigan Army Medical Center

  2. Introduction • Diabetes affects approximately 18.2 million • Sixth leading cause of death • Direct care is in excess of $90 billion dollars

  3. Introduction • Minorities more likely to have diabetes • Healthy People 2010: eliminate health disparities • Access often cited as a cause • No studies in a military setting

  4. Hypothesis Nonwhite adult diabetics are more likely to have poorer outcome measures than white diabetic patients despite universal access

  5. Methods • Cross-sectional design • All adults • MAMC diabetic database for at least one year • Data Sources: DEERS, ICDB, CHCS

  6. Methods • Main outcome variables: • LDL in the last two years • HbA1C in the last twelve months • Urinalysis in the past 12 months • BP within the last 12 months

  7. Results: Demographics • 3789 patients - 51.5% female • 48% Caucasians • 8% African-American • 5.6% Asian • 5.1% Other • 11.1% Unknown

  8. Results: Population Means Age 64 years old SBP 137 mm Hg DBP 71 mm Hg LDL 94 mg/dl A1C 7.1% Urinalysis 82.9%* UA performed in the past year

  9. Results: SBP • Caucasian mean: 136 mmHg • African-Americans: 4.79 mm Hg higher • Asian: 2.52 mm Hg lower • Other: 1.76 mm Hg higher • Unknown: 2.77 mm Hg higher

  10. Results: DBP • Caucasian mean: 70 mm Hg • African-Americans: 3.46 mm Hg higher • Asian: .92 mm Hg higher • Other: 1.26 mm Hg higher • Unknown: 2.23 mm Hg higher

  11. Results: HbA1C • Caucasian mean: 6.96% • African-Americans: .25 higher • Asian: .14 higher • Other: .12 higher • Unknown: .03 higher

  12. Results: LDL • Caucasian mean: 90 mg/dl • African-Americans: 11 mg/dl higher • Asian: 1.43 mg/dl higher • Other: 5.1 mg/dl higher • Unknown: 6.03 mg/dl higher

  13. Results: Summary • African-Americans: • SBP: 141mm Hg • DBP: 74 mm Hg • HbA1C: 7.3 % • LDL: 102 mg/dl • 85% had urinalysis

  14. Discussion • African-American race was associated with poorer outcomes measures in all areas

  15. Discussion: Clinical Impact • 1% reduction in HbA1C • 37% reduction in microvascular • 14% reduction in MI • 21% reduction in all cause mortality • Any HbA1C > 6% confers risk

  16. Discussion: Clinical Impact • SBP decrease by 10 mm Hg: • 13% reduction in microvascular • 11% reduction in MI • 15% reduction in all cause mortality

  17. Discussion: Limitations • Absence of a Hispanic category • Surrogate measures • Confounders: • Severity of disease • Treatments • Number of visits

  18. Conclusion • African-Americans are more likely to have a higher BP, LDL and HbA1C • Access is only one contributing factor • Genetic etiology along with exploring other nongenetic causes

  19. Questions?

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