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Ethnic disparities in risk of cardiovascular disease, end‐stage renal disease and all‐cause mortality: a prospective study among Asian people with Type 2 diabetes
Author(s) -
Liu J. J.,
Lim S. C.,
Yeoh L. Y.,
Su C.,
Tai B. C.,
Low S.,
Fun S.,
Tavintharan S.,
Chia K. S.,
Tai E. S.,
Sum C. F.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13020
Subject(s) - medicine , hazard ratio , diabetes mellitus , malay , albuminuria , kidney disease , disease , renal function , prospective cohort study , end stage renal disease , proportional hazards model , type 2 diabetes mellitus , confidence interval , endocrinology , linguistics , philosophy
Aim To study prospectively the ethnic‐specific risks of cardiovascular disease, end‐stage renal disease and all‐cause mortality in patients with Type 2 diabetes mellitus among native Asian subpopulations. Methods A total of 2337 subjects with Type 2 diabetes (70% Chinese, 17% Malay and 13% Asian Indian) were followed for a median of 4.0 years. Time‐to‐event analysis was used to study the association of ethnicity with adverse outcomes. Results Age‐ and gender‐adjusted hazard ratios for cardiovascular disease in ethnic Malay and Asian Indian subjects were 2.01 (1.40–2.88; P <0.0001) and 1.60 (1.07–2.41; P =0.022) as compared with Chinese subjects. Adjustment for conventional cardiovascular disease risk factors, including HbA 1c , blood pressure and lipid profile, slightly attenuated the hazards in Malay (1.82, 1.23–2.71; P =0.003) and Asian Indian subjects (1.47, 0.95–2.30; P =0.086); However, further adjustment for baseline renal function (estimated GFR ) and albuminuria weakened the cardiovascular disease risks in Malay (1.48, 0.98–2.26; P =0.065) but strengthened that in Asian Indian subjects (1.81, 1.14–2.87; P =0.012). Competing‐risk regression showed that the age‐ and gender‐adjusted sub‐distribution hazard ratio for end‐stage renal disease was 1.87 (1.27–2.73; P =0.001) in Malay and 0.39 (0.18–0.83; P =0.015) in Asian Indian subjects. Notably, the difference in end‐stage renal disease risk among the three ethnic groups was abolished after further adjustment for baseline estimated GFR and albuminuria. There was no significant difference in risk of all‐cause mortality among the three ethnic groups. Conclusions Risks of cardiovascular and end‐stage renal diseases in native Asian subjects with Type 2 diabetes vary substantially among different ethnic groups. Differences in prevalence of diabetic kidney disease may partially explain the ethnic disparities.