Parrinello Christina M, Rastegar Ina, Godino Job G, Miedema Michael D, Matsushita Kunihiro, Selvin Elizabeth
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Baltimore Polytechnic Institute, Baltimore, MD.
Diabetes Care. 2015 Jul;38(7):1290-8. doi: 10.2337/dc15-0016. Epub 2015 Apr 7.
Controversy surrounds appropriate risk factor targets in older adults with diabetes. We evaluated the proportion of older adults with diabetes meeting different targets, focusing on possible differences by race, and assessed whether demographic and clinical characteristics explained disparities.
We conducted a cross-sectional study of 5,018 participants aged 67-90 years (1,574 with and 3,444 without diagnosed diabetes) who attended visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (2011-2013). Risk factor targets were defined using both stringent (and less stringent) goals: hemoglobin A1c (HbA1c) <7%, <53 mmol/mol (<8%, <64 mmol/mol); LDL cholesterol (LDL-c) <100 mg/dL (<130 mg/dL); and blood pressure (BP) <140/90 mmHg (<150/90 mmHg). We used Poisson regression to obtain prevalence ratios (PRs).
Most older adults with diabetes met stringent (and less stringent) targets: 72% (90%) for HbA1c, 63% (86%) for LDL-c, and 73% (87%) for BP; but only 35% (68%) met all three. A higher proportion of whites than blacks met targets, however defined. Among people treated for risk factors, racial disparities in prevalence of meeting stringent targets persisted even after adjustment: PRs (whites vs. blacks) were 1.03 (95% CI 0.91, 1.17) for HbA1c, 1.21 (1.09, 1.35) for LDL-c, 1.10 (1.00, 1.21) for BP, and 1.28 (0.99, 1.66) for all three. Results were similar but slightly attenuated using less stringent goals. Black women were less likely than white women to meet targets for BP and all three risk factors; this disparity was not observed in men.
Black-white disparities in risk factor control in older adults with diabetes were not fully explained by demographic or clinical characteristics and were greater in women than men. Further study of determinants of these disparities is important.
老年糖尿病患者合适的风险因素目标存在争议。我们评估了达到不同目标的老年糖尿病患者比例，重点关注种族差异，并评估人口统计学和临床特征是否能解释这些差异。
我们对参加社区动脉粥样硬化风险（ARIC）研究第5次访视（2011 - 2013年）的5018名67 - 90岁参与者进行了横断面研究（其中1574名患有糖尿病，3444名未患糖尿病）。风险因素目标采用严格（和较宽松）的标准定义：糖化血红蛋白（HbA1c）<7%，<53 mmol/mol（<8%，<64 mmol/mol）；低密度脂蛋白胆固醇（LDL - c）<100 mg/dL（<130 mg/dL）；血压（BP）<140/90 mmHg（<150/90 mmHg）。我们使用泊松回归获得患病率比（PRs）。
大多数老年糖尿病患者达到了严格（和较宽松）的目标：HbA1c为72%（90%），LDL - c为63%（86%），血压为73%（87%）；但只有35%（68%）达到了所有三个目标。无论如何定义，达到目标的白人比例高于黑人。在接受风险因素治疗的人群中，即使经过调整，达到严格目标的患病率种族差异仍然存在：HbA1c的PRs（白人对黑人）为1.03（95%CI 0.91，1.17），LDL - c为1.21（1.09，1.35），血压为1.10（1.00，1.21），所有三个目标的PRs为1.28（0.99，1.66）。使用较宽松目标时结果相似但略有减弱。黑人女性达到血压目标和所有三个风险因素目标的可能性低于白人女性；男性中未观察到这种差异。
老年糖尿病患者风险因素控制方面的黑白差异不能完全由人口统计学或临床特征解释，且女性差异大于男性。进一步研究这些差异的决定因素很重要。
