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Article
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
University of Massachusetts Medical School Faculty Publications
  • Yunsheng Ma, University of Massachusetts Medical School
  • James R. Hebert, University of South Carolina - Columbia
  • Raji Balasubramanian, University of Massachusetts Amherst
  • Nicole M. Wedick, University of Massachusetts Medical School
  • Barbara V. Howard, MedStar Health Research Institute
  • Milagros C. Rosal, University of Massachusetts Medical School
  • Simin Liu, University of California at Los Angeles
  • Chloe E. Bird, RAND Corporation
  • Barbara C Olendzki, UMass Medical School
  • Judith K. Ockene, University of Massachusetts Medical School
  • Jean Wactawski-Wende, State University of New York at Buffalo
  • Lawrence S. Phillips, Emory University
  • Michael J. Lamonte, State University of New York at Buffalo
  • Kristin L. Schneider, Rosalind Franklin University of Medicine and Science
  • Lorena Garcia, University of California - Davis
  • Ira S. Ockene, University of Massachusetts Medical School
  • Philip A. Merriam, University of Massachusetts Medical School Worcester
  • Deidre M. Sepavich, University of Massachusetts Medical School
  • Rachel H. Mackey, University of Pittsburgh - Main Campus
  • Karen C. Johnson, University of Tennessee Health Science Center
  • JoAnn E. Manson, Harvard Medical School
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Medicine, Division of Cadiovascular Medicine
Publication Date
11-15-2013
Document Type
Article
Subjects
Cardiovascular Diseases; Continental Population Groups; Diabetes Mellitus; Neoplasms; Postmenopause
Abstract

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.

Keywords
  • UMCCTS funding
DOI of Published Version
10.1093/aje/kwt177
Source

Ma Y, HĂ©bert JR, Balasubramanian R, Wedick NM, Howard BV, Rosal MC, Liu S, Bird CE, Olendzki BC, Ockene JK, Wactawski-Wende J, Phillips LS, Lamonte MJ, Schneider KL, Garcia L, Ockene IS, Merriam PA, Sepavich DM, Mackey RH, Johnson KC, Manson JE. 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. Am J Epidemiol. 2013 Nov 15;178(10):1533-41. doi: 10.1093/aje/kwt177. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID
24045960
Citation Information
Yunsheng Ma, James R. Hebert, Raji Balasubramanian, Nicole M. Wedick, et al.. "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" Vol. 178 Iss. 10 (2013) ISSN: 0002-9262 (Linking)
Available at: http://works.bepress.com/barbara_olendzki/65/