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%26apos;s Health Initiative, 1993-2009

作者：Ma Yunsheng^*; Hebert 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

来源：American Journal of Epidemiology, 2013, 178(10): 1533-1541.

DOI：10.1093/aje/kwt177

• diabetes
• health disparities
• menopause
• mortality
• obesity
• womens health

Using data from the Womens Health Initiative (19932009; 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 23 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.

• 出版日期2013-11-15