Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora CO.
Biostatistics and Data Sciences Wake Forest University School of Medicine Winston-Salem NC.
J Am Heart Assoc. 2023 Apr 4;12(7):e028529. doi: 10.1161/JAHA.122.028529. Epub 2023 Mar 30.
Background We examined arterial stiffness in individuals with type 1 diabetes, and explored whether differences between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) individuals were attributable to modifiable clinical and social factors. Methods and Results Participants (n=1162; 22% Hispanic, 18% NHB, and 60% NHW) completed 2 to 3 research visits from ≈10 months to ≈11 years post type 1 diabetes diagnosis (mean ages of ≈9 to ≈20 years, respectively) providing data on socioeconomic factors, type 1 diabetes characteristics, cardiovascular risk factors, health behaviors, quality of clinical care, and perception of clinical care. Arterial stiffness (carotid-femoral pulse wave velocity [PWV], m/s) was measured at ≈20 years of age. We analyzed differences in PWV by race and ethnicity, then explored the individual and combined impact of the clinical and social factors on these differences. PWV did not differ between Hispanic (adjusted mean 6.18 [SE 0.12]) and NHW (6.04 [0.11]) participants after adjustment for cardiovascular risks (=0.06) and socioeconomic factors (=0.12), or between Hispanic and NHB participants (6.36 [0.12]) after adjustment for all factors (=0.08). PWV was higher in NHB versus NHW participants in all models (all <0.001). Adjustment for modifiable factors reduced the difference in PWV by 15% for Hispanic versus NHW participants; by 25% for Hispanic versus NHB; and by 21% for NHB versus NHW. Conclusions Cardiovascular and socioeconomic factors explain one-quarter of the racial and ethnic differences in PWV of young people with type 1 diabetes, but NHB individuals still experienced greater PWV. Exploration of pervasive inequities potentially driving these persistent differences is needed.
我们研究了 1 型糖尿病患者的动脉僵硬度,并探讨了西班牙裔、非西班牙裔黑人(NHB)和非西班牙裔白人(NHW)个体之间的差异是否归因于可改变的临床和社会因素。
参与者(n=1162;22%为西班牙裔,18%为 NHB,60%为 NHW)在 1 型糖尿病诊断后约 10 个月至 11 年期间完成了 2 到 3 次研究访视(平均年龄约为 9 到 20 岁),提供了关于社会经济因素、1 型糖尿病特征、心血管危险因素、健康行为、临床护理质量和临床护理感知的数据。在约 20 岁时测量动脉僵硬度(颈股脉搏波速度 [PWV],m/s)。我们分析了种族和民族之间 PWV 的差异,然后探讨了临床和社会因素对这些差异的个体和综合影响。在调整心血管风险因素(=0.06)和社会经济因素(=0.12)后,西班牙裔(调整后的平均 PWV 为 6.18 [0.12])和 NHW(6.04 [0.11])参与者之间的 PWV 没有差异,或者在调整所有因素后(=0.08),西班牙裔和 NHB 参与者之间的 PWV 也没有差异(6.36 [0.12])。在所有模型中,NHB 参与者的 PWV 均高于 NHW 参与者(均<0.001)。可改变因素的调整使西班牙裔与 NHW 参与者之间的 PWV 差异减少了 15%;西班牙裔与 NHB 之间减少了 25%;NHB 与 NHW 之间减少了 21%。
心血管和社会经济因素解释了 1 型糖尿病青少年 PWV 种族和民族差异的四分之一,但 NHB 个体的 PWV 仍然更高。需要探索潜在的普遍不平等现象,这些现象可能导致这些持续存在的差异。