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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.
PMID
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Authors

Mayor MeshTerms

African Americans

European Continental Ancestry Group

Health Status Disparities

Keywords
Journal Title jama
Publication Year Start




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.