All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, Hispanic, and Asian women with and without diabetes in the United States: the Women's Health Initiative, 1993-2009.

MedStar author(s):
Citation: American Journal of Epidemiology. 178(10):1533-41, 2013 Nov 15.PMID: 24045960Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, U.S. Gov't, P.H.S.Subject headings: *Cardiovascular Diseases/mo [Mortality] | *Continental Population Groups/sn [Statistics & Numerical Data] | *Diabetes Mellitus/ep [Epidemiology] | *Neoplasms/mo [Mortality] | *Postmenopause | African Americans | Aged | Asian Americans | Body Weights and Measures | Cardiovascular Diseases/eh [Ethnology] | Diet | Estrogen Replacement Therapy/sn [Statistics & Numerical Data] | European Continental Ancestry Group | Exercise | Female | Hispanic Americans | Humans | Middle Aged | Neoplasms/eh [Ethnology] | Proportional Hazards Models | Residence Characteristics/sn [Statistics & Numerical Data] | Risk Factors | Smoking/ep [Epidemiology] | United States/ep [Epidemiology]Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 0002-9262
Name of journal: American journal of epidemiologyAbstract: Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.All authors: Balasubramanian R, Bird CE, Garcia L, Hebert JR, Howard BV, Johnson KC, Lamonte MJ, Liu S, Ma Y, Mackey RH, Manson JE, Merriam PA, Ockene IS, Ockene JK, Olendzki BC, Phillips LS, Rosal MC, Schneider KL, Sepavich DM, Wactawski-Wende J, Wedick NMDigital Object Identifier: Date added to catalog: 2014-02-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 24045960

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the "amplifying" effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes.

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