All-cause, Cardiovascular, and Cancer Mortality Rates in Postmenopausal White, Black, Hispanic, and Asian Women with and Without Diabetes in the United States

The Women's Health Initiative, 1993-2009

Published In: American Journal of Epidemiology, v. 178, no. 10, Nov. 2013, p. 1533-1541

Posted on RAND.org on November 01, 2013

by Yunsheng Ma, James R. Hebert, Raji Balasubramanian, Nicole M. Wedick, Barbara V Howard, Milagros C. Rosal, Simin Liu, Chloe E. Bird, Barbara Olendzki, Judith Ockene, Jean Wactawski-Wende, Lawrence S. Phillips, Michael J. Lamonte, Kristin L. Schneider, Lorena Garcia, Ira S. Ockene, Philip A. Merriam, Deidre M. Sepavich, Rachel H. Mackey, Karen C. Johnson, JoAnn E Manson

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Using data from the Women's Health Initiative (1993–2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2–3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.

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