Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC
Center for Health Disparities, East Carolina University Brody School of Medicine, Greenville, NC.
Diabetes Care. 2021 May;44(5):1151-1158. doi: 10.2337/dc20-1710. Epub 2021 May 6.
To examine if the association between higher A1C and risk of cardiovascular disease (CVD) among adults with and without diabetes is modified by racial residential segregation.
The study used a case-cohort design, which included a random sample of 2,136 participants at baseline and 1,248 participants with incident CVD (i.e., stroke, coronary heart disease [CHD], and fatal CHD during 7-year follow-up) selected from 30,239 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants originally assessed between 2003 and 2007. The relationship of A1C with incident CVD, stratified by baseline diabetes status, was assessed using Cox proportional hazards models adjusting for demographics, CVD risk factors, and socioeconomic status. Effect modification by census tract-level residential segregation indices (dissimilarity, interaction, and isolation) was assessed using interaction terms.
The mean age of participants in the random sample was 64.2 years, with 44% African American, 59% female, and 19% with diabetes. In multivariable models, A1C was not associated with CVD risk among those without diabetes (hazard ratio [HR] per 1% [11 mmol/mol] increase, 0.94 [95% CI 0.76-1.16]). However, A1C was associated with an increased risk of CVD (HR per 1% increase, 1.23 [95% CI 1.08-1.40]) among those with diabetes. This A1C-CVD association was modified by the dissimilarity ( < 0.001) and interaction ( = 0.001) indices. The risk of CVD was increased at A1C levels between 7 and 9% (53-75 mmol/mol) for those in areas with higher residential segregation (i.e., lower interaction index). In race-stratified analyses, there was a more pronounced modifying effect of residential segregation among African American participants with diabetes.
Higher A1C was associated with increased CVD risk among individuals with diabetes, and this relationship was more pronounced at higher levels of residential segregation among African American adults. Additional research on how structural determinants like segregation may modify health effects is needed.
探讨在有或无糖尿病的成年人中，糖化血红蛋白（A1C）与心血管疾病（CVD）风险之间的关联是否受种族居住隔离的影响。
本研究采用病例-队列设计，纳入了基线时 2136 名参与者的随机样本，以及在 30239 名最初于 2003 年至 2007 年期间接受评估的 REasons for Geographic And Racial Differences in Stroke（REGARDS）研究参与者中，经过 7 年随访期间发生 CVD（即中风、冠心病[CHD]和致命性 CHD）的 1248 名参与者。使用 Cox 比例风险模型评估 A1C 与基线糖尿病状态分层后的 CVD 事件之间的关系，模型中调整了人口统计学、CVD 风险因素和社会经济地位。使用交互项评估基于普查区层面的居住隔离指数（不相似性、交互作用和隔离）的效应修饰作用。
随机样本参与者的平均年龄为 64.2 岁，其中 44%为非裔美国人，59%为女性，19%患有糖尿病。在多变量模型中，A1C 与无糖尿病者的 CVD 风险无关（每增加 1%[11mmol/mol]的风险比[HR]，0.94[95%CI 0.76-1.16]）。然而，A1C 与糖尿病患者的 CVD 风险增加相关（每增加 1%的 HR，1.23[95%CI 1.08-1.40]）。这种 A1C 与 CVD 的关联受到不相似性（<0.001）和交互作用（=0.001）指数的修饰。在居住隔离程度较高的地区（即交互指数较低），A1C 水平在 7-9%（53-75mmol/mol）之间时，CVD 风险增加。在按种族分层的分析中，在糖尿病的非裔美国参与者中，居住隔离的修饰作用更为明显。
A1C 升高与糖尿病患者的 CVD 风险增加有关，而在非洲裔美国成年人中，这种关联在居住隔离程度较高时更为明显。需要进一步研究居住隔离等结构性决定因素如何可能改变健康影响。
