Mayeda Elizabeth R, Karter Andrew J, Huang Elbert S, Moffet Howard H, Haan Mary N, Whitmer Rachel A
Corresponding author: Rachel A. Whitmer,
Diabetes Care. 2014 Apr;37(4):1009-15. doi: 10.2337/dc13-0215. Epub 2013 Nov 22.
OBJECTIVE Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients. RESEARCH DESIGN AND METHODS We identified 22,171 diabetic patients without preexisting dementia aged ≥60 years (14,546 non-Hispanic whites, 2,484 African Americans, 2,363 Latinos, 2,262 Asians, 516 Native Americans) from the Kaiser Permanente Northern California Diabetes Registry. We abstracted prevalent medical history (1 January 1996 to 31 December 1997) and dementia incidence (1 January 1998 to 31 December 2007) from medical records and calculated age-adjusted incidence densities. We fit Cox proportional hazards models adjusted for age, sex, education, diabetes duration, and markers of clinical control. RESULTS Dementia was diagnosed in 3,796 (17.1%) patients. Age-adjusted dementia incidence densities were highest among Native Americans (34/1,000 person-years) and African Americans (27/1,000 person-years) and lowest among Asians (19/1,000 person-years). In the fully adjusted model, hazard ratios (95% CIs) (relative to Asians) were 1.64 (1.30-2.06) for Native Americans, 1.44 (1.24-1.67) for African Americans, 1.30 (1.15-1.47) for non-Hispanic whites, and 1.19 (1.02-1.40) for Latinos. Adjustment for diabetes-related complications and neighborhood deprivation index did not change the results. CONCLUSIONS Among type 2 diabetic patients followed for 10 years, African Americans and Native Americans had a 40-60% greater risk of dementia compared with Asians, and risk was intermediate for non-Hispanic whites and Latinos. Adjustment for sociodemographics, diabetes-related complications, and markers of clinical control did not explain observed differences. Future studies should investigate why these differences exist and ways to reduce them.
目的 尽管2型糖尿病患者患痴呆症的风险加倍，但该人群中痴呆症风险的潜在种族/族裔差异尚未得到探讨。我们评估了老年糖尿病患者中痴呆症的种族/族裔差异及潜在的解释因素。 研究设计与方法 我们从北加利福尼亚凯撒医疗集团糖尿病登记处识别出22171名年龄≥60岁且无既往痴呆症的糖尿病患者（14546名非西班牙裔白人、2484名非裔美国人、2363名拉丁裔、2262名亚裔、516名美洲原住民）。我们从病历中提取了1996年1月1日至1997年12月31日的常见病史以及1998年1月1日至2007年12月31日的痴呆症发病率，并计算了年龄调整后的发病率密度。我们拟合了经年龄、性别、教育程度、糖尿病病程和临床控制指标调整的Cox比例风险模型。 结果 3796名（17.1%）患者被诊断为痴呆症。年龄调整后的痴呆症发病率密度在美洲原住民（34/1000人年）和非裔美国人（27/1000人年）中最高，在亚裔中最低（19/1000人年）。在完全调整模型中，与亚裔相比，美洲原住民的风险比（95%置信区间）为1.64（1.30 - 2.06），非裔美国人为1.44（1.24 - 1.67），非西班牙裔白人为1.30（1.15 - 1.47），拉丁裔为1.19（1.02 - 1.40）。对糖尿病相关并发症和邻里贫困指数进行调整后，结果未改变。 结论 在随访10年的2型糖尿病患者中，与亚裔相比，非裔美国人和美洲原住民患痴呆症的风险高40% - 60%，非西班牙裔白人和拉丁裔的风险处于中等水平。对社会人口统计学、糖尿病相关并发症和临床控制指标进行调整并不能解释观察到的差异。未来的研究应调查这些差异存在的原因以及减少差异的方法。
