Association of Modifiable Risk Factors in Young Adulthood With Racial Disparity in Incident Type 2 Diabetes During Middle Adulthood.
|Abstract||In the United States, black individuals are twice as likely to develop type 2 diabetes compared with white individuals, and these disparities are particularly pronounced in young and middle age. Prior studies have identified differences in traditional risk factors that may be associated with racial disparities in diabetes incidence but have not simultaneously adjusted for risk factors measured across multiple domains (eg, the individual and the environment) and updated over time.|
Lack of racial disparity in incident prediabetes and glycemic progression among black and white offspring of parents with type 2 diabetes: the pathobiology of prediabetes in a biracial cohort (POP-ABC) study.
|Publication Year Start||2018-01-01|
PMID- 29279935 OWN - NLM STAT- MEDLINE DCOM- 20180108 LR - 20180108 IS - 1538-3598 (Electronic) IS - 0098-7484 (Linking) VI - 318 IP - 24 DP - 2017 Dec 26 TI - Association of Modifiable Risk Factors in Young Adulthood With Racial Disparity in Incident Type 2 Diabetes During Middle Adulthood. PG - 2457-2465 LID - 10.1001/jama.2017.19546 [doi] AB - Importance: In the United States, black individuals are twice as likely to develop type 2 diabetes compared with white individuals, and these disparities are particularly pronounced in young and middle age. Prior studies have identified differences in traditional risk factors that may be associated with racial disparities in diabetes incidence but have not simultaneously adjusted for risk factors measured across multiple domains (eg, the individual and the environment) and updated over time. Objective: To determine the relative associations of modifiable biological, neighborhood, psychosocial, socioeconomic, and behavioral factors in young adulthood with the observed racial disparity in diabetes incidence between middle-aged black and white individuals. Design, Setting, and Participants: Black and white men and women from the observational Coronary Artery Risk Development in Young Adults study, aged 18 to 30 years, without diabetes at baseline (1985-1986; N = 4251) were observed through 2015-2016. Sex-stratified multivariable-adjusted Cox proportional hazards modeling, with adjustment for time-updated covariates, was used to estimate risk for incident diabetes. Percent reduction in the beta coefficient (the logarithm used to calculate the hazard ratio [HR]) was calculated to compare black to white participants. Exposures: Self-identified race and factors including biological (eg, fasting glucose, body mass index), neighborhood (racial segregation and tract-level poverty), psychosocial (depressive symptoms), socioeconomic (eg, personal and parental educational attainment, current employment), and behavioral (eg, regular alcohol consumption, smoking) domains. Main Outcomes and Measures: Incident type 2 diabetes mellitus. Results: The mean (SD) age at baseline was 25 (3.6) years, 49% (n = 2066) of the sample was black, and 54% (n = 2304) were women. Over a mean follow-up of 24.5 years, 504 cases of incident diabetes were identified. Using sex-stratified multivariable-adjusted Cox proportional hazards models, black women and men were more likely to develop diabetes than white men and women (black women: HR, 2.86 [95% CI, 2.19-3.72] and risk difference [RD], 89 cases/1000 people [95% CI, 61-117]; black men: HR, 1.67 [95% CI, 1.28-2.17] and RD, 47 cases/1000 people [95% CI, 15-78]) after adjustment for age and center. Biological factors were most strongly associated with the disparity in diabetes risk between black and white individuals for women (percent reduction in beta, 112%) and men (percent reduction in beta, 86%). There was no longer disparity in diabetes risk between black and white middle-aged adults after adjustment for biological, neighborhood, psychosocial, socioeconomic, and behavioral factors measured over time (HR for women, 0.79 [95% CI, 0.55-1.14]; HR for men, 0.92 [95% CI, 0.62-1.38]). Conclusions and Relevance: In this cohort study comparing black and white participants, there was a statistically significant increased risk of incident type 2 diabetes among black women and men. However, after adjustment for modifiable risk factors during young adulthood, the disparity was no longer statistically significant. FAU - Bancks, Michael P AU - Bancks MP AD - Northwestern University, Chicago, Illinois. FAU - Kershaw, Kiarri AU - Kershaw K AD - Northwestern University, Chicago, Illinois. FAU - Carson, April P AU - Carson AP AD - University of Alabama at Birmingham. FAU - Gordon-Larsen, Penny AU - Gordon-Larsen P AD - University of North Carolina at Chapel Hill. FAU - Schreiner, Pamela J AU - Schreiner PJ AD - University of Minnesota, Minneapolis. FAU - Carnethon, Mercedes R AU - Carnethon MR AD - Northwestern University, Chicago, Illinois. LA - eng GR - R01 HL114091/HL/NHLBI NIH HHS/United States GR - T32 HL069771/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, N.I.H., Intramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA JT - JAMA JID - 7501160 RN - 0 (Lipids) SB - AIM SB - IM MH - Adult MH - *African Americans MH - Body Mass Index MH - Cohort Studies MH - Diabetes Mellitus, Type 2/*ethnology MH - *European Continental Ancestry Group MH - Female MH - *Health Status Disparities MH - Humans MH - Lipids/blood MH - Male MH - Middle Aged MH - Proportional Hazards Models MH - Residence Characteristics MH - Retrospective Studies MH - Risk Factors MH - Socioeconomic Factors EDAT- 2017/12/28 06:00 MHDA- 2018/01/09 06:00 CRDT- 2017/12/28 06:00 PHST- 2017/12/28 06:00 [entrez] PHST- 2017/12/28 06:00 [pubmed] PHST- 2018/01/09 06:00 [medline] AID - 2667072 [pii] AID - 10.1001/jama.2017.19546 [doi] PST - ppublish SO - JAMA. 2017 Dec 26;318(24):2457-2465. doi: 10.1001/jama.2017.19546.