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

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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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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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