Abstract
Using data from theWomen'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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1533-1541 |
| Number of pages | 9 |
| Journal | American Journal of Epidemiology |
| Volume | 178 |
| Issue number | 10 |
| DOIs | |
| State | Published - Nov 15 2013 |
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Keywords
- Diabetes
- Health disparities
- Menopause
- Mortality
- Obesity
- Women's health
ASJC Scopus subject areas
- Epidemiology
Cite this
All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, hispanic, and asianwomenwith andwithout diabetes in the United States : The Women's Health Initiative, 1993-2009. / Ma, Yunsheng; Hébert, James R.; Balasubramanian, Raji; Wedick, Nicole M.; Howard, Barbara V.; Rosal, Milagros C.; Liu, Simin; Bird, Chloe E.; Olendzki, Barbara C.; Ockene, Judith K.; Wactawski-Wende, Jean; Phillips, Lawrence S.; LaMonte, Michael J.; Schneider, Kristin L.; Garcia, Lorena; Ockene, Ira S.; Merriam, Philip A.; Sepavich, Deidre M.; Mackey, Rachel H.; Johnson, Karen C.; Manson, Joann E.
In: American Journal of Epidemiology, Vol. 178, No. 10, 15.11.2013, p. 1533-1541.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, hispanic, and asianwomenwith andwithout diabetes in the United States
T2 - The Women's Health Initiative, 1993-2009
AU - Ma, Yunsheng
AU - Hébert, James R.
AU - Balasubramanian, Raji
AU - Wedick, Nicole M.
AU - Howard, Barbara V.
AU - Rosal, Milagros C.
AU - Liu, Simin
AU - Bird, Chloe E.
AU - Olendzki, Barbara C.
AU - Ockene, Judith K.
AU - Wactawski-Wende, Jean
AU - Phillips, Lawrence S.
AU - LaMonte, Michael J.
AU - Schneider, Kristin L.
AU - Garcia, Lorena
AU - Ockene, Ira S.
AU - Merriam, Philip A.
AU - Sepavich, Deidre M.
AU - Mackey, Rachel H.
AU - Johnson, Karen C.
AU - Manson, Joann E.
PY - 2013/11/15
Y1 - 2013/11/15
N2 - Using data from theWomen'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.
AB - Using data from theWomen'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.
KW - Diabetes
KW - Health disparities
KW - Menopause
KW - Mortality
KW - Obesity
KW - Women's health
UR - http://www.scopus.com/inward/record.url?scp=84890101748&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890101748&partnerID=8YFLogxK
U2 - 10.1093/aje/kwt177
DO - 10.1093/aje/kwt177
M3 - Article
C2 - 24045960
AN - SCOPUS:84890101748
VL - 178
SP - 1533
EP - 1541
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
SN - 0002-9262
IS - 10
ER -