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Diabetes risk higher, mortality risk lower among Asian vs. white adults
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Asian adults in the U.S. are at least 20% more likely to develop type 2 diabetes over the course of a decade than their white counterparts, yet they are 40% less likely to die of any cause, according to an analysis of National Health Interview Survey data.
“Despite the lower body mass index in Asian-Americans, type 2 diabetes is more prevalent in Asians since 2000, particularly among Filipinos and Asian Indians,” Hsin-Chieh Jessica Yeh, PhD, associate professor of medicine, epidemiology and oncology at Johns Hopkins University, told Endocrine Today. “This observation highlights the importance of diabetes prevention in Asians. The second finding is Asians have lower total and CVD mortality risks than whites among those with diabetes. Asian patients with diabetes should continue to pay attention to diabetes control to lower the risk for complications.”
Yeh and Jiwon R. Lee, MD, of the Samsung Health Research Institute in Hwaseong, South Korea, analyzed data from 15,881 Asian adults and 221,473 white adults aged at least 30 years interviewed for the National Health Interview Survey (NHIS) between 2000 and 2014. Researchers additionally linked pooled NHIS data from 2000 to 2009 with data from the National Death Index for 7,822 Asian adults and 136,816 white adults. Researchers used analysis of covariance with age and BMI as continuous variables to compare baseline characteristics for Asian and white adults and used linear regression models to examine the mean differences of age- and sex-adjusted type 2 diabetes prevalence between the earlier NHIS sample (2000-2002) and the later sample (2012-2014), as well as overall trends in both races. Cause-specific mortality HRs were determined using Cox proportional hazard models.
Researchers found that type 2 diabetes prevalence was higher among Asian vs. white adults throughout the study period.
The prevalence of type 2 diabetes in Asian adults increased from 8.1% in 2000-2002 to 9.6% in 2012-2014 (P for trend = .04), whereas in white adults, prevalence increased from 6% in 2000-2002 to 7.9% in 2012-2014 (P for trend < .0001).
During 12 years of follow-up, 401 Asian adults and 15,226 white adults died. Regardless of diabetes status, researchers found that Asian adults had lower age-standardized mortality rates vs. white adults for any cause of death. For participants with diabetes, the age-standardized overall mortality rate was 72.7 per 1,000 person-years for Asian adults and 138.8 per 1,000 person-years for white adults. For participants without diabetes, overall mortality rates were 58.1 and 77.8 per 1,000 person-years for Asian and white adults, respectively.
Among Asian and white adults with diabetes, HRs for total and CVD mortality were 0.7 (95% CI, 0.5-0.9) and 0.3 (95% CI, 0.1-0.6), respectively, with no difference in cancer mortality.
Additionally, Asian adults with diabetes were 40% less likely to die of any cause vs. white adults (HR = 0.6; 95% CI, 0.4-0.7) and 70% less likely to die of CV causes vs. white adults with diabetes (HR = 0.3; 95% CI, 0.1-0.5). Results persisted after adjustment for age and sex.
There were no between-group differences in total or cause-specific mortality in Asian and white adults without diabetes, according to the researchers.
“Asian-Americans and their doctors should pay closer attention to diabetes prevention, such as preventing weight gain and screening for diabetes,” Yeh said. “The American Diabetes Association recommends testing for diabetes be considered in Asians with a BMI of 23 kg/m² or higher, with other risk factors. In addition, effective strategies to promote physical activities in Asians are needed.”
Yeh said less muscle mass and more abdominal fat leading to insulin resistance in Asian adults could be the possible mechanism behind the increased diabetes risk; however, additional studies can help researchers develop new prevention strategies.
“Moreover, intervention studies, particularly those increasing physical activity and tailored to Asian culture and lifestyle, are needed,” Yeh said. – by Regina Schaffer
For more information:
Hsin-Chieh Jessica Yeh, PhD, can be reached at Johns Hopkins University, Department of Medicine and Epidemiology, 2024 E. Monument St., Suite 2-500, Baltimore, MD 21205; email: hyeh1@jhmi.edu.
Disclosures: The authors report no relevant financial disclosures.
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