Young Bessie A, Katon Wayne J, Von Korff Michael, Simon Greg E, Lin Elizabeth H B, Ciechanowski Paul S, Bush Terry, Oliver Malia, Ludman Evette J, Boyko Edward J
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
J Am Soc Nephrol. 2005 Jan;16(1):219-28. doi: 10.1681/ASN.2004030162. Epub 2004 Nov 24.
The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.
本研究的目的是确定在一个能获得同等医疗保健服务的大型初级保健人群中，是否观察到糖尿病微量白蛋白尿患病率存在种族或民族差异。对一个大型区域健康维护组织的2969名初级保健糖尿病患者的调查和自动化实验室数据进行了横断面分析。研究数据针对完成了一项评估人口统计学、糖尿病护理和抑郁情况的调查的糖尿病登记确诊患者，分析了微量白蛋白尿（30至300毫克白蛋白/克肌酐）和大量白蛋白尿（>300毫克白蛋白/克肌酐）患病率的种族/民族差异。将计算机化的药房、医院和实验室数据与调查数据相链接以进行分析。通过无条件逻辑回归评估微量白蛋白尿和大量白蛋白尿几率的种族/民族差异，并按高血压情况进行分层。在接受检测的人群中，微量或大量白蛋白尿的未调整患病率为30.9%，在不同种族/民族群体中相似。在无高血压的人群中，与白人相比，亚洲人的微量白蛋白尿患病率高出两倍（优势比[OR]2.01；95%置信区间[CI]1.14至3.53），大量白蛋白尿患病率高出三倍（OR 3.17；95%CI 1.09至9.26）。在有高血压的人群中，西班牙裔的微量白蛋白尿调整后几率高于白人（OR 3.82；95%CI 1.16至12.57），而黑人的大量白蛋白尿调整后几率比白人高出三倍（OR 3.32；95%CI 1.26至8.76）。对于大多数种族/民族少数群体，高甘油三酯血症与微量和大量白蛋白尿的较高几率显著相关。在一个大型初级保健人群中，根据高血压状况，微量白蛋白尿和大量白蛋白尿的调整患病率存在种族/民族差异。在这种情况下，尽管获得糖尿病护理的机会相当，但仍观察到早期糖尿病肾病存在种族/民族差异。
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