Ethnic disparities in diabetic complications in an insured population

Karter, Andrew J.

doi:10.1001/jama.287.19.2519

Cited by 840Health disparities and outcomesDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

Ethnic disparities in diabetic complications in an insured population

Karter, Andrew J.·2002·JAMA

DOI 10.1001/jama.287.19.2519

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Abstract

CONTEXT: Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health care coverage may be useful. OBJECTIVE: To assess ethnic disparities in the incidence of diabetic complications within a nonprofit prepaid health care organization. DESIGN AND SETTING: Longitudinal observational study conducted January 1, 1995, through December 31, 1998, at Kaiser Permanente Medical Care Program in northern California. PARTICIPANTS: A total of 62 432 diabetic patients, including Asians (12%), blacks (14%), Latinos (10%), and whites (64%). MAIN OUTCOME MEASURES: Incident myocardial infarction (MI), stroke, congestive heart failure (CHF), and nontraumatic lower extremity amputation (LEA), defined by primary hospitalization discharge diagnosis, procedures, or underlying cause of death; and end-stage renal disease (ESRD), defined as renal insufficiency requiring renal replacement therapy or transplantation for survival or by underlying cause of death. RESULTS: Patterns of ethnic differences were not consistent across complications and frequently persisted despite adjustment for a wide range of demographic, socioeconomic, behavioral, and clinical factors. Adjusted hazard ratios (relative to that of whites) were 0.56, 0.68, and 0.68 for blacks, Asians, and Latinos, respectively (P<.001), for MI; 0.76 and 0.72 for Asians and Latinos, respectively (P<.01), for stroke; 0.70 and 0.61 for Asians and Latinos, respectively (P<.01), for CHF; 0.40 for Asians (P<.001) for LEA; and 2.03, 1.85, and 1.46 for blacks, Asians, and Latinos, respectively (P<.01), for ESRD. There were no statistically significant black-white differences for stroke, CHF, or LEA and no Latino-white differences for LEA. CONCLUSIONS: This study confirms previous reports of elevated incidence of ESRD among ethnic minorities, despite uniform medical care coverage, and provides new evidence that rates of other complications are similar or lower relative to those of whites. The persistence of ethnic disparities after adjustment suggests a possible genetic origin, the contribution of unmeasured environmental factors, or a combination of these factors.

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The National Institute on Aging Health Disparities Research Framework
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Disparities in HbA1c Levels Between African-American and Non-Hispanic White Adults With Diabetes
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Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015
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Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial
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Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System: Adherence, Renal Safety, and Discontinuation
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Incidence, microbiology, and patient characteristics of skin and soft-tissue infections in a U.S. population: a retrospective population-based study
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CKD and the Risk of Incident Cancer
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Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States
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Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus
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Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act
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Diabetes in African Americans
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COPD as a Systemic Disease: Impact on Physical Functional Limitations
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Genetic Factors in Diabetic Nephropathy
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Neighborhood Poverty and Racial Differences in ESRD Incidence
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Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care
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Explaining the black-white disparity in preterm birth: a consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes
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Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008
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Poverty, Race, and CKD in a Racially and Socioeconomically Diverse Urban Population
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Analysis of 16,192 Anterior Cruciate Ligament Reconstructions From a Community-Based Registry
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Metabolic Syndrome Predicts New Onset of Chronic Kidney Disease in 5,829 Patients With Type 2 Diabetes
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Yearly Trends in Elective Shoulder Arthroplasty, 2005–2013
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Cohort Study of Pioglitazone and Cancer Incidence in Patients With Diabetes
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Alcohol consumption is inversely associated with adherence to diabetes self‐care behaviours
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Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans
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The need for research in primary care.
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Patient Factors Associated With Prolonged Postoperative Opioid Use After Total Knee Arthroplasty
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Disparities in A1C Levels Between Hispanic and Non-Hispanic White Adults With Diabetes
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Diabetes and Associated Complications in the South Asian Population
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IFSO-APC Consensus Statements 2011
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Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus
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Absolute Rates of Heart Failure, Coronary Heart Disease, and Stroke in Chronic Kidney Disease
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Directly measured second hand smoke exposure and asthma health outcomes
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New Prescription Medication Gaps: A Comprehensive Measure of Adherence to New Prescriptions
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Body composition and functional limitation in COPD
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Diabetes mellitus type 2 in urban Ghana: characteristics and associated factors
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Race, socioeconomic status, and air pollution exposure in North Carolina
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Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD
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Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes
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Racial/Ethnic Disparities in Potentially Preventable Readmissions: The Case of Diabetes
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Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events
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Use of Medicare’s diabetes self-management training benefit
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Risks for End-Stage Renal Disease, Cardiovascular Events, and Death in Hispanic versus Non-Hispanic White Adults with Chronic Kidney Disease
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Association of Sickle Cell Trait With Hemoglobin A<sub>1c</sub> in African Americans
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Characteristics of Patients With Type 2 Diabetes in Mexico
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Medical costs associated with type 2 diabetes complications and comorbidities.
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Place matters: Neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE)
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Epidemiology of Type 2 Diabetes: Focus on Ethnic Minorities
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Socioeconomic Status and the Incidence of ESRD
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Association of Depression With Increased Risk of Dementia in Patients With Type 2 Diabetes
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Chronic Kidney Disease Japan Cohort (CKD-JAC) Study: Design and Methods
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Cohort Profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population†
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The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry
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Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study
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Impact of depressive symptoms on adult asthma outcomes
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HIV infection and incidence of ischemic stroke
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Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease
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Ethnic Disparities in Diabetic Complications
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1352-P: Ethnic Disparities in Diabetic Complications in the U.S.
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Racial Disparities in Diabetic Complications in an Underinsured Population
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Heterogeneity of Diabetes Outcomes Among Asians and Pacific Islanders in the U.S.
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Self-citation
Abstract P153: Racial Disparities in Diabetic Complications in a Middle and Low Income Population of Louisiana
Wang, Y., Li, W., Chen, L., Horswell, R. L., Xie, W., Xiao, K., Besse, J. A., Johnson, J. L., Katzmarzyk, P. T., Ryan, D. H., et al. (2012) · Circulation · doi:10.1161/circ.125.suppl_10.ap153

Authors: Karter, A. J.
Affiliations: Kaiser Permanente (US)
Corresponding author: Karter, Andrew J.
ORCID: Karter, Andrew J.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2002-05-15
Volume: 287
Issue: 19
Pages: 2519
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.287.19.2519
OpenAlex: W2062541896
Semantic Scholar: 45adbdb2692a3a7316ef76ffa5ae54dbc5659118
Cited by: 840
References: 65
Citations by year: 2026: 7 · 2025: 11 · 2024: 16 · 2023: 39 · 2022: 36 · 2021: 39 · 2020: 33 · 2019: 31 · 2018: 34 · 2017: 35 · 2016: 34 · 2015: 50 · 2014: 36 · 2013: 62 · 2012: 41
FWCI: 35.02
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Health › Health disparities and outcomes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: ethnic disparities, diabetes complications, end-stage renal disease, myocardial infarction, stroke, congestive heart failure, lower limb amputation, racial and ethnic minorities, prepaid health care, Kaiser Permanente Medical Care Program, health care access, diabetes incidence, Asian Americans, Hispanic Americans, African Americans, white, insured population, Northern California
MeSH terms: Amputation, Surgical, Diabetes Mellitus, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Neuropathies, Ethnicity, Female, Health Maintenance Organizations, Heart Failure, Humans, Kidney Failure, Chronic, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Socioeconomic Factors, United States, Incidence, Multivariate Analysis, Stroke, Diabetes Complications

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Ethnic disparities in diabetic complications in an insured population

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