Bertoni Alain G, Kirk Julienne K, Case L Douglas, Kay Christine, Goff David C, Narayan K M Venkat, Bell Ronny A
Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
Diabetes Care. 2005 Nov;28(11):2620-5. doi: 10.2337/diacare.28.11.2620.
There is conflicting evidence about whether nonwhite Americans with diabetes have an increased risk of cardiovascular disease (CVD). Because geographic region is known to influence the risk of CVD in the U.S., we sought to determine the effects of race and region on cardiovascular morbidity among elderly Americans with diabetes.
We performed a national, retrospective, cohort study using the Medicare claims of 126,153 white and 17,962 black patients with diabetes, aged > or =65 years in 1994, who were followed through 1999 for incident acute myocardial infarction, ischemic heart disease, stroke, and heart failure. The effect of race, sex, and region on the incidence of these diseases was assessed using Cox proportional hazards regression, adjusting for baseline demographics and comorbidities.
The incidence of any CVD ranged from 23.9/100 person-years among southern black men to 29.2/100 person-years among non-southern black women. The risk of CVD was lower among southern black men (hazard ratio 0.87 [95% CI 0.82-0.92]) and women (0.95 [0.91-0.99]) than their southern white counterparts. In the three other U.S. regions combined (northeast, midwest, and west), black men had a similar risk for CVD (1.01 [0.95-1.07]), and black women had a greater risk (1.10 [1.05-1.16]) than non-southern white men and women, respectively.
Among elderly Americans with diabetes, the incidence of CVD is unlikely to differ a great deal between whites and blacks. Residence in the South seems to confer a modest benefit for elderly black people with diabetes.
关于患有糖尿病的非裔美国人患心血管疾病（CVD）风险是否增加，证据存在冲突。由于已知地理区域会影响美国的CVD风险，我们试图确定种族和区域对老年糖尿病美国人心血管疾病发病率的影响。
我们进行了一项全国性的回顾性队列研究，使用了1994年年龄≥65岁的126,153名白人糖尿病患者和17,962名黑人糖尿病患者的医疗保险理赔数据，对其随访至1999年，观察急性心肌梗死、缺血性心脏病、中风和心力衰竭的发病情况。使用Cox比例风险回归评估种族、性别和区域对这些疾病发病率的影响，并对基线人口统计学和合并症进行调整。
任何心血管疾病的发病率范围从南部黑人男性的23.9/100人年到非南部黑人女性的29.2/100人年。南部黑人男性（风险比0.87 [95%可信区间0.82 - 0.92]）和女性（0.95 [0.91 - 0.99]）患心血管疾病的风险低于其南部白人同龄人。在美国其他三个地区（东北部、中西部和西部）合并计算时，黑人男性患心血管疾病的风险相似（1.01 [0.95 - 1.07]），而黑人女性的风险分别高于非南部白人男性和女性（1.10 [1.05 - 1.16]）。
在患有糖尿病的老年美国人中，白人和黑人之间心血管疾病的发病率不太可能有很大差异。居住在南方似乎对患有糖尿病的老年黑人有一定益处。
