CV and Cancer Mortality in Women With and Without Diabetes
CV and Cancer Mortality in Women With and Without Diabetes
Among the 158,833 women included in the analyses, the average age was 63 years; 84.1% were white (n = 133,541), 9.2% were black (n = 14,618), 4.1% were Hispanic (n = 6,484), and 2.6% were Asian (n = 4,190). At baseline, 4.4% of the participants had a history of diabetes diagnosis (n = 7,169). The annual incidence of reported diabetes diagnosis or medication initiation was 0.80%, and the cumulative incidence was 5.45% (n = 10,307 incident diabetes cases) over 1,288,375 person-years of follow-up. Baseline characteristics of women who reported diabetes at baseline or during follow-up versus women who did not report diabetes during the study are summarized in Table 1 and Table 2. In general, women who reported diabetes had higher baseline body mass indexes and worse dietary quality scores, were less active, and had more medical conditions, including hypertension and high cholesterol, than did women who did not report having diabetes.
In multivariable-adjusted analyses, within each race/ethnicity subgroup, women with diabetes were had a 2–3 times higher risk of all-cause, CVD, and cancer mortality than did those without diabetes (Table 3). Adjustment for a range of potential confounders, including CVD risk factors, family history of CVD, and neighborhood socioeconomic status, caused a similar modest attenuation of hazard ratios for all race/ethnicity categories, except for a smaller attenuation among Asian women. However, all confidence intervals within each race/ethnicity category overlapped all of the others. The percentages of women with prevalent or incident diabetes from study enrollment to August 2009 were, in decreasing frequency, 27.1% for blacks, 20.8% for Hispanics, 15.9% for Asians, and 11.7% for whites. PARP takes into account both the prevalence of diabetes and the risk associated with the disease. 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). For CVD mortality, a similar pattern was observed; the PARP for diabetes appeared to be highest in Hispanics (30.6, 95% CI: 8.7, 49.7) and then in blacks (25.9, 95% CI: 17.8, 33.7) compared with whites, who had statistically lower PARPs with smaller confidence intervals than did blacks (14.9, 95% CI: 12.7, 17.1), but not Hispanics, who had very wide 95% confidence interval. For cancer mortality, the PARPs for diabetes appeared higher for Hispanic and Asian women than for either black or white women; however, in relation to group mean differences, confidence intervals were relatively wide and overlapping.
Results
Among the 158,833 women included in the analyses, the average age was 63 years; 84.1% were white (n = 133,541), 9.2% were black (n = 14,618), 4.1% were Hispanic (n = 6,484), and 2.6% were Asian (n = 4,190). At baseline, 4.4% of the participants had a history of diabetes diagnosis (n = 7,169). The annual incidence of reported diabetes diagnosis or medication initiation was 0.80%, and the cumulative incidence was 5.45% (n = 10,307 incident diabetes cases) over 1,288,375 person-years of follow-up. Baseline characteristics of women who reported diabetes at baseline or during follow-up versus women who did not report diabetes during the study are summarized in Table 1 and Table 2. In general, women who reported diabetes had higher baseline body mass indexes and worse dietary quality scores, were less active, and had more medical conditions, including hypertension and high cholesterol, than did women who did not report having diabetes.
In multivariable-adjusted analyses, within each race/ethnicity subgroup, women with diabetes were had a 2–3 times higher risk of all-cause, CVD, and cancer mortality than did those without diabetes (Table 3). Adjustment for a range of potential confounders, including CVD risk factors, family history of CVD, and neighborhood socioeconomic status, caused a similar modest attenuation of hazard ratios for all race/ethnicity categories, except for a smaller attenuation among Asian women. However, all confidence intervals within each race/ethnicity category overlapped all of the others. The percentages of women with prevalent or incident diabetes from study enrollment to August 2009 were, in decreasing frequency, 27.1% for blacks, 20.8% for Hispanics, 15.9% for Asians, and 11.7% for whites. PARP takes into account both the prevalence of diabetes and the risk associated with the disease. 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). For CVD mortality, a similar pattern was observed; the PARP for diabetes appeared to be highest in Hispanics (30.6, 95% CI: 8.7, 49.7) and then in blacks (25.9, 95% CI: 17.8, 33.7) compared with whites, who had statistically lower PARPs with smaller confidence intervals than did blacks (14.9, 95% CI: 12.7, 17.1), but not Hispanics, who had very wide 95% confidence interval. For cancer mortality, the PARPs for diabetes appeared higher for Hispanic and Asian women than for either black or white women; however, in relation to group mean differences, confidence intervals were relatively wide and overlapping.
