ASCVD hospitalizations elevated in Black adults with diabetes
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A new study highlights a significant cumulative increase in the rate of hospitalizations for atherosclerotic CVD in Black adults with diabetes.
“The issue of disparities related to race, ethnicity, sex/gender, socioeconomic status and geography have come to the forefront not only in cardiovascular medicine, but in general health care and public health,” Keith C. Ferdinand, MD, FACC, FAHA, FASPC, Gerald S. Berenson Chair in Preventive Cardiology, professor of medicine at Tulane University School of Medicine and Cardiology Today Editorial Board Member, told Healio. “We wanted to see if there were national data specifically related to hospitalization in persons with diabetes that will help us understand what is going on presently and what to expect in the future, related to diabetes and ASCVD.”
Researchers analyzed patients in the 2005-2015 National Inpatient Sample who were aged at least 40 years with a primary diagnosis of ASCVD and a secondary diagnosis of diabetes. Overall, there were 5,409,501 inpatient hospitalizations among Black and white individuals from 2005 to 2015.
The rate of total ASCVD hospitalizations with comorbid of diabetes increased from 2005 to 2015 by 5.7% in Black men and by 4% in Black women, whereas the hospitalization rate in white adults was relatively unchanged. The increase in ASCVD hospitalizations was primarily driven by higher admission for stroke, which accounted for 29.9% of inpatient ASCVD hospitalizations in 2005 vs. 41.7% in 2015, according to the results.
There was an increasing trend in ASCVD hospitalization rates among Black men and women from 2005 to 2010, and decreasing hospitalization rates of ASCVD with diabetes from 2011 to 2014, according to the results.
Compared with hospitalizations among white adults, hospitalizations among Black adults included those who were younger (mean age, 69 years vs. 64 years; P < .001), more likely female (50.1% vs. 58.3%; P < .01), more likely to have Medicaid insurance (5.9% vs. 14.9%; P < .001) and more likely to reside in the poorest household ZIP codes (26.8% vs. 51.9%; P < .001), the researchers reported.
The researchers reported higher odds of ASCVD hospitalization if a patient presented with comorbid hypertension (OR = 1.29; 95% CI, 1.28-1.31), dyslipidemia (OR = 2.03; 95% CI, 2.01-2.05), renal failure (OR = 1.84; 95% CI, 1..82-1.86) or smoking/substance abuse (OR = 1.31; 95% CI, 1.29-1.33). Obesity was associated with lower odds of ASCVD hospitalization with comorbid diabetes (OR = 0.83; 95% CI, 0.82-0.84).
The highest risk-adjusted incidence of ASCVD-related in-hospital mortality was in white women (4.2%), relative to Black women (3.9%), compared with white men (3.6%) and Black men (3.5%), according to the results.
“As a society, we have not solved the racial/ethnic disparities puzzle. Ongoing efforts will be needed to remove these unfortunate and unacceptable disparate rates in heart disease,” Ferdinand said. “While many clinicians tend to underappreciate the burden of ASCVD and women with diabetes, we noted high rates of hospitalization in women, suggesting to some extent that being female and having diabetes is predictive of an increase in ASCVD burden and hospitalization.”
The researchers concluded that further research is needed to understand the associations in this study.
“In the future, with newer antidiabetic medicines being utilized based on the evidence for protection against heart disease, heart failure and chronic kidney disease, it will be important to ensure that the benefits of these medications, such as the GLP-1 agonists and SGLT2 inhibitors, are used regardless of race, ethnicity, sex, gender and social class,” Ferdinand told Healio.
For more information:
Keith C. Ferdinand, MD, FACC, FAHA, FASPC, can be reached at kferdina@tulane.edu.
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