Lipton R B, Liao Y, Cao G, Cooper R S, McGee D
Department of Preventive Medicine and Epidemiology, Stritch School of Medicine, Loyola University, Maywood, IL 60153.
Am J Epidemiol. 1993 Nov 15;138(10):826-39. doi: 10.1093/oxfordjournals.aje.a116786.
The excess incidence of non-insulin-dependent diabetes mellitus noted among African Americans in the past two decades may be attributable to variations in the distribution of specific risk factors, or the impact of these risk factors may differ by ethnicity or sex. Over the 16 years (1971-1987) of the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, 880 incident cases of diabetes mellitus developed among 11,097 white and black participants who were between the ages of 25 and 70 years at baseline. There were substantial differences among the four race/sex groups with respect to age at baseline, as well as marked differences in the distribution of several major risk factors for diabetes, including obesity, subscapular and triceps skinfold thickness, blood pressure, income, activity, and educational level. The age-adjusted incidence of diabetes over the course of the study was 15.0% among black women, while it was 10.9% among black men. White women and men experienced similar, more moderate risks of 7.0% and 6.9%, respectively. The 100% excess risk among black women and the 50% excess among black men can in large measure explain the recent marked increase in diabetes rates in the black community. Furthermore, at nearly every level of obesity, blacks had a higher risk of diabetes than whites, suggesting that other factors contributed to risk. A significant interaction between race and body mass index (weight (kg)/height(m)2) was likewise demonstrated in multivariate analysis. Baseline age, race, body mass index, and ratio of subscapular skinfold to triceps skinfold were significantly related to incident diabetes, both overall and in separate models for men and women; in the entire cohort and in women alone, blood pressure, activity level, and education also contributed to risk. Other interactions were tested but were not found to be important. Despite sampling difficulties and inconsistencies in the data, the NHANES I Epidemiologic Follow-up Study provides evidence that the associations of anthropometric and sociodemographic variables with diabetes may vary among subgroups which have different mean levels and distributions of these risk factors.
在过去二十年中，非胰岛素依赖型糖尿病在非裔美国人中的发病率过高，这可能归因于特定风险因素分布的差异，或者这些风险因素的影响可能因种族或性别而异。在第一次全国健康和营养检查调查（NHANES I）流行病学随访研究的16年（1971 - 1987年）期间，在11,097名基线年龄在25至70岁之间的白人和黑人参与者中，出现了880例糖尿病新发病例。四个种族/性别组在基线年龄方面存在显著差异，在糖尿病的几个主要风险因素分布上也存在明显差异，包括肥胖、肩胛下和肱三头肌皮褶厚度、血压、收入、活动和教育水平。在研究过程中，经年龄调整后的糖尿病发病率在黑人女性中为15.0%，在黑人男性中为10.9%。白人女性和男性的风险相似，分别为7.0%和6.9%，相对适中。黑人女性中100%的额外风险以及黑人男性中50%的额外风险在很大程度上可以解释近期黑人社区糖尿病发病率的显著上升。此外，在几乎每个肥胖水平上，黑人患糖尿病的风险都高于白人，这表明其他因素也会导致患病风险。在多变量分析中同样显示出种族与体重指数（体重（千克）/身高（米）²）之间存在显著的相互作用。基线年龄、种族、体重指数以及肩胛下皮褶与肱三头肌皮褶的比例与糖尿病发病均显著相关，无论是总体情况还是在男性和女性的单独模型中都是如此；在整个队列以及仅在女性中，血压、活动水平和教育程度也会增加患病风险。还测试了其他相互作用，但未发现其具有重要意义。尽管存在抽样困难和数据不一致的情况，但NHANES I流行病学随访研究提供了证据，表明人体测量和社会人口统计学变量与糖尿病之间的关联在具有不同这些风险因素平均水平和分布的亚组中可能有所不同。
