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African health:Diabetes Disparities Among Racial and Ethnic Minorities

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The burden of diabetes is much higher for racial/ethnic minorities than for whites. Minorities have a higher prevalence of diabetes than whites, and some minorities have higher rates of diabetes-related complications and death. Research results help in understanding these disparities and ways to reduce them.

High Diabetes Rates for Minorities
Identifying disparities is a first step toward understanding what causes them and what can be done to reduce them.

•Different studies found that African Americans are from 1.4 to 2.2 times more likely to have diabetes than white persons.
•Hispanic Americans have a higher prevalence of diabetes than non-Hispanic people, with the highest rates for type 2 diabetes among Puerto Ricans and Hispanic people living in the Southwest and the lowest rate among Cubans.
•The prevalence of diabetes among American Indians is 2.8 times the overall rate.
•Major groups within the Asian and Pacific Islander communities (Japanese Americans, Chinese Americans, Filipino Americans, and Korean Americans) all had higher prevalences than those of whites.
High Complication Rates for Minorities
Although minorities are more likely than whites to be diagnosed with diabetes, the rates of complications vary by disease and minority group.2

Kidney Disease
Diabetes is the most frequently reported cause of kidney failure in the United States. In 1990, it was the underlying cause of kidney failure in 34 percent of patients starting treatment for end stage renal disease (ESRD). Diabetes-related kidney failure affects a much higher percentage of African Americans than whites.3 An AHRQ-funded study of renal disease found that:

•The rate of diabetic ESRD is 2.6 times higher among African Americans than among whites.3
•From 1988 to 1990, the annual incidence of new cases of diabetes-related ESRD was 137 per million African Americans, compared to 38 cases per million whites.3
•ESRD is more likely to be related to type 2 diabetes among African Americans than it is among whites.3
•Rates of early stage kidney disease (proteinuria) are higher among Hispanic Americans, African Americans, and American Indians than among the white population.2
The AHRQ-funded study also found that the proportion of ESRD attributable to diabetes was similar in whites (44 percent) and blacks (41 percent).

The reasons that African Americans have more diabetes-related ESRD are unclear. African Americans have much higher rates of hypertension than whites. The interaction between hypertension and type 2 diabetes, which occur together more frequently in African Americans than in whites, may account for the higher rate of ESRD. Another factor could be a difference in the quality of care furnished to African-American patients with type 2 diabetes.3

Eye Disease
Another serious complication of diabetes is retinopathy, which, if untreated, can cause blindness.

Diabetic retinopathy is the major cause of blindness among adults ages 20 to 74.

•Rates of blindness due to diabetes are only half as high for whites as they are for rest of the population.
•Two studies of retinopathy in Hispanic Americans showed conflicting results, with one showing higher rates and the other showing lower rates than whites.
•Pima Indians in Arizona and Native Americans in Oklahoma have both been shown to have higher rates of retinopathy than whites.2
Coronary Artery Disease
People with diabetes are at greater risk for heart disease than the general population. Although there do not appear to be consistent disparities in diabetes-related coronary artery disease between minorities and white persons, an AHRQ-funded study has found that African-American diabetic patients are more likely than whites to have a particular lipid profile: low HDLs (high-density lipoproteins), high LDLs (low-density lipoproteins), but lower triglycerides than among whites. This is important because having too few HDLs, too many LDLs, or too many triglycerides are all risk factors for heart disease. Therefore, the researchers recommend that, in treating dyslipidemia (imbalances among HDLs, LDLs, and triglycerides) among African Americans, clinicians should focus primarily on improving LDLs and HDLs.4

Other Conditions
No consistent evidence exists that shows disparities between minorities and whites for diabetes-related neuropathy and peripheral vascular disease. However, African Americans and American Indians have higher rates of lower-extremity amputations than white persons.2

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Mortality
Diabetes-related mortality rates for African Americans, Hispanic Americans, and American Indians are higher than those for white people. Asians and Pacific Islanders have the lowest diabetes-related mortality of any racial/ethnic group in America.

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