3041 — Racial and Ethnic Differences in All-Cause Mortality in a National Cohort of Veterans with Type 2 Diabetes
Hunt KJ (REAP - Charleston), Gebregziabher M
(REAP - Charleston), Lynch CP
(REAP - Charleston), Axon RN
(REAP - Charleston), Gilbert GE
(REAP - Charleston), Carrae E
(REAP - Charleston), Mauldin PD
(REAP - Charleston), Egede LE
(REAP - Charleston)
Previous studies have examined racial and ethnic mortality differences among individuals with diabetes; however, few studies have examined differences in a managed care setting such as the VHA while controlling for medication adherence. Therefore, we examined the relationship between race/ethnicity and all-cause mortality in a national cohort of veterans with type 2 diabetes controlling for relevant covariates.
The study population consisted of 690,968 veterans with diabetes receiving prescriptions for insulin or oral hypoglycemic agents in 2002 who were followed until death, loss to follow-up, or through December 2006. Covariates included demographics (i.e., age, sex, marital status, service connectedness, rural/urban residence, geographic region), ICD-9 coded comorbidities, HbA1c, medication type and medication adherence defined by having a medication possession ratio of > = 80%. Hazard ratios (HRs) were calculated comparing non-Hispanic blacks (NHB), Hispanics and other/unknown/missing (OTH) to non-Hispanic Whites (NHW).
The study population was 72.86% NHW, 12.85% NHB, 5.11% Hispanic and 9.18% OTH, with a mean age 65.77 ± 11.17 years in 2002. During the follow-up period 34.24% died. After adjusting for demographic factors mortality HRs relative to NHWs were 1.01 (95% CI: 0.99, 1.02), 0.85 (95% CI: 0.83, 0.87) and 0.62 (95% CI: 0.60, 0.64) for NHB, Hispanic and OTH, respectively. Further adjusting for comorbidities, reduced HRs slightly in NHB [HR = 0.94 (95% CI: 0.92, 0.95 )] and attenuated HRs slightly in OTH [HR = 0.74 (95% CI:0.72, 0.76)], but did not alter HRs in Hispanics [HR = 0.84 (95% CI: 0.82, 0.87)]. Further, adjusting for HbA1c, mediation type and medication adherence reduced HRs in NHB [HR = 0.79 (95% CI:0.77, 0.80)], Hispanics [HR = 0.79 (95% CI:0.77, 0.81 )] and OTH [HR = 0.64 (95% CI: 0.62, 0.66)] .
After controlling for demographics, Hispanics have a mortality advantage over NHW, while NHB do not. After further controlling for comorbidities, glycemic control and medication adherence, both Hispanics and NHB have a lower mortality risk than NHW.
In the VHA where racial/ethnic disparities in access to care are absent, controlling for differences in glycemic control, medication type and medication adherence increases the mortality advantage of NHB and Hispanic veterans with type 2 diabetes. Further studies of patient, provider and system-level factors are required.