Swenson Carolyn J, Trepka Mary Jo, Rewers Marian J, Scarbro Sharon, Hiatt William R, Hamman Richard F
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Am J Epidemiol. 2002 Nov 15;156(10):919-28. doi: 10.1093/aje/kwf140.
Despite a worse cardiovascular disease (CVD) risk profile, Hispanics have lower CVD mortality than non-Hispanic Whites in studies based on death certificates. This study examined 310 deaths that occurred between 1984 and 1998 among 1,862 Hispanic and non-Hispanic White participants in the San Luis Valley Diabetes Study, using medical records to classify cause of death. Among persons without diabetes, the age-adjusted all-cause mortality rate was 6.1/1,000 person-years in non-Hispanic Whites and 7.4/1,000 person-years in Hispanics. Among persons with diabetes, it was 24.3/1,000 person-years in non-Hispanic Whites and 21.9/1,000 person-years in Hispanics. Among nondiabetics, the age-adjusted CVD mortality rate was 2.5/1,000 person-years in non-Hispanic Whites and 1.6/1,000 person-years in Hispanics. Among diabetics, it was 12.9/1,000 person-years in non-Hispanic Whites and 8.8/1,000 person-years in Hispanics. Among nondiabetics, the adjusted hazard ratio for CVD death in Hispanics compared with non-Hispanic Whites was 0.65 (95% confidence interval (CI): 0.34, 1.23). The hazard ratio for coronary heart disease death was 0.95 (95% CI: 0.35, 2.59). Among diabetics, the hazard ratio for CVD death, after adjustment for conventional and diabetes risk factors, was 0.44 (95% CI: 0.26, 0.74), and for coronary heart disease death it was 0.43 (95% CI: 0.21, 0.91). A statistically significant decreased risk of CVD death was observed only in male Hispanics with diabetes. Competing mortality or factors that interact with diabetes may explain these differences.
尽管西班牙裔人群的心血管疾病（CVD）风险状况更差，但在基于死亡证明的研究中，他们的CVD死亡率低于非西班牙裔白人。本研究调查了圣路易斯谷糖尿病研究中1862名西班牙裔和非西班牙裔白人参与者在1984年至1998年间发生的310例死亡病例，使用医疗记录对死因进行分类。在无糖尿病者中，非西班牙裔白人的年龄调整全因死亡率为6.1/1000人年，西班牙裔为7.4/1000人年。在糖尿病患者中，非西班牙裔白人的年龄调整全因死亡率为24.3/1000人年，西班牙裔为21.9/1000人年。在非糖尿病者中，非西班牙裔白人的年龄调整CVD死亡率为2.5/1000人年，西班牙裔为1.6/1000人年。在糖尿病患者中，非西班牙裔白人的年龄调整CVD死亡率为12.9/1000人年，西班牙裔为8.8/1000人年。在非糖尿病者中，西班牙裔与非西班牙裔白人相比，CVD死亡的调整后风险比为0.65（95%置信区间（CI）：0.34，1.23）。冠心病死亡的风险比为0.95（95%CI：0.35，2.59）。在糖尿病患者中，在调整了传统和糖尿病风险因素后，CVD死亡的风险比为0.44（95%CI：0.26，0.74），冠心病死亡的风险比为0.43（95%CI：0.21，0.91）。仅在患有糖尿病的西班牙裔男性中观察到CVD死亡风险有统计学意义的降低。相互竞争的死亡率或与糖尿病相互作用的因素可能解释了这些差异。
