Egede LE (Charleston VAMC Targeted Research Enhancement Program (TREP)), Zhao Y
(Charleston VAMC TREP), Mueller M
(Charleston VAMC TREP), Mauldin PD
(Charleston VAMC TREP), Chen GJ
(Charleston VAMC TREP), Durkalski VL
(Charleston VAMC TREP), Moran PW
(Charleston VAMC TREP)
Prior studies in non-VA settings have documented that African Americans with diabetes have higher mortality than Whites. However, few studies have assessed racial/ethnic differences in risk of death among diabetic persons in an equal access system such as the VA. This study examined racial/ethnic differences in all-cause mortality among veterans with type 2 diabetes.
Cohort study of 14,931 veterans with Type 2 diabetes was created by merging multiple DSS datasets for the Charleston VA catchment area. Diabetes was defined using established algorithms for identifying type 2 diabetes in VA administrative data. The cohort was followed from January 8, 1996 to either date of death or March 2, 2006. Cox proportional hazards regression model was used to calculate the multivariate-adjusted hazard ratio (HR) of death from all causes across 3 racial/ethnic groups – non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Other (HO). Covariates included age at baseline, gender, race/ethnicity, employment, marital status, and comorbidity including stroke, cancer, heart disease, hypertension, congestive heart failure, and depression. All statistical tests used a 2-tailed a=0.05 level of significance and were performed using SAS statistical software.
Mean age of the sample was 64 years. 97% were men. 47% were non-Hispanic whites, 26% were non-Hispanic Blacks, 0.8% were Hispanic, and ~26% had no race/ethnicity information. 65% were married and 48% were unemployed. Over a mean follow-up period of 5 years, 16% of the cohort or 2,330 people died. After adjusting for covariates and using non-Hispanic Whites as reference, the Hazard Ratios for death by race/ethnicity were as follows: non-Hispanic Blacks (HR 0.68, 95% CI 061, 0.76), Hispanic/Other (HR 0.89, 95% CI 0.52, 1.54), and missing race/ethnicity (HR 1.19, 95% CI 1.05, 1.35).
At this VA medical center, non-Hispanic Blacks had significantly lower hazards of death compared to non-Hispanic Whites.
In contrast to what obtains in non-VA settings, risk of death is significantly lower among Blacks with type 2 diabetes compared to Whites. Although the reasons for lower mortality in Blacks could not be ascertained in this study, it may reflect the benefit of equal access to care and improved quality of care in the VA system.