Ethnic Disparities in Diabetic Complications in an Insured Population

作者：Andrew J. Karter · 发表于：JAMA · 年份：2002 · DOI：10.1001/jama.287.19.2519 · 被引用次数：844 · 研究领域：Diabetes Management and Education、Renal Transplantation Outcomes and Treatments、Diabetic Foot Ulcer Assessment and Management

CONTEXT: Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health care coverage may be useful. OBJECTIVE: To assess ethnic disparities in the incidence of diabetic complications within a nonprofit prepaid health care organization. DESIGN AND SETTING: Longitudinal observational study conducted January 1, 1995, through December 31, 1998, at Kaiser Permanente Medical Care Program in northern California. PARTICIPANTS: A total of 62 432 diabetic patients, including Asians (12%), blacks (14%), Latinos (10%), and whites (64%). MAIN OUTCOME MEASURES: Incident myocardial infarction (MI), stroke, congestive heart failure (CHF), and nontraumatic lower extremity amputation (LEA), defined by primary hospitalization discharge diagnosis, procedures, or underlying cause of death; and end-stage renal disease (ESRD), defined as renal insufficiency requiring renal replacement therapy or transplantation for survival or by underlying cause of death. RESULTS: Patterns of ethnic differences were not consistent across complications and frequently persisted despite adjustment for a wide range of demographic, socioeconomic, behavioral, and clinical factors. Adjusted hazard ratios (relative to that of whites) were 0.56, 0.68, and 0.68 for blacks, Asians, and Latinos, respectively (...