Risks for CKD, heart failure higher for Black vs. white adults with type 2 diabetes
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Black adults with type 2 diabetes have a higher risk for developing chronic kidney disease and heart failure than white adults, and the time from diabetes diagnosis to CKD or heart failure was 12 years or less in all age groups.
In findings published in Diabetes Care from more than 1.5 million U.S. residents with type 2 diabetes, risks for developing CKD and heart failure varied by ethnicity, age group and sex. Additionally, most age groups with type 2 diabetes developed CKD and heart failure within a decade of type 2 diabetes diagnosis, and CKD had a greater mediation effect on the risk difference in heart failure compared with the mediation effects of heart failure on CKD risk differences between Black and white adults.
“We believe that the large cohort size, robust study design, use of advanced data mining methods, and appropriate assessment of confounders ensure reliable population-level estimates and reflect real-world patterns of CKD and heart failure risk in people with incident type 2 diabetes in a detailed evaluation by age, ethnicity and sex,” Sanjoy K. Paul, PhD, professor of clinical epidemiology and biostatistics at Melbourne EpiCentre, University of Melbourne and Melbourne Health, Australia, and colleagues wrote. “Our findings relative to different risk paradigms in African Americans and white Americans, including a mediation effect difference of heart failure and CKD, reflect the inherent differences in how the pathway of development of cardiometabolic diseases differ in these ethnic groups.”
Researchers analyzed deidentified patient-level data from the Centricity electronic medical record database. White adults (n = 1,491,672) and Black adults (n = 311,333) aged 18 to 70 years diagnosed with type 2 diabetes from 2000 to September 2018 were included. Participants were stratified into four groups based on age at type 2 diabetes onset: 18 to 39 years, 40 to 49 years, 50 to 59 years and 60 to 70 years. The presence of CKD and heart failure were confirmed through relevant disease identification codes. Researchers assessed the risks, mediation effects and time to diagnosis of CKD and heart failure for both Black and white adults as well as for each age group.
Higher risks for Black adults
The risk for developing CKD among adults with type 2 diabetes was higher for Black adults compared with white adults aged 18 to 39 years (HR = 1.21; 95% CI, 1.17-1.26), 40 to 49 years (HR = 1.25; 95% CI, 1.22-1.28), 50 to 59 years (HR = 1.21; 95% CI, 1.19-1.24) and 60 to 70 years (HR = 1.1; 95% CI, 1.08-1.12). Black adults with type 2 diabetes also had a higher risk for heart failure than white adults aged 18 to 39 years (HR = 2.21; 95% CI, 1.98-2.45), 40 to 49 years (HR = 1.86; 95% CI, 1.75-1.97) and 50 to 59 years (HR = 1.54; 95% CI, 1.48-1.6). No significant difference in heart failure risk was found for adults aged 60 to 70 years.
After stratifying further by sex, Black men aged 18 to 59 years had an 11% to 49% higher risk for developing CKD than women. White men aged 18 to 39 years had a 23% higher risk for CKD than women, whereas white men aged 50 years and older had a 7% to 14% lower CKD risk than women (P < .01 for all).
Time to CKD, heart failure less than 10 years for most
The mean time from diabetes diagnosis to first CKD event was between 5.1 and 9.7 years across all age groups in Black and white adults with type 2 diabetes. The time from diabetes diagnosis to CKD was 3.6 years longer for Black adults aged 18 to 39 years compared with those aged 60 to 70 years. White adults aged 18 to 39 years had a time to CKD event 4 years longer than those aged 60 to 70 years.
The mean time from diabetes diagnosis to a heart failure event was between 6.9 and 12.1 years across all age groups. The time to a heart failure event was 3.4 years longer in Black adults aged 18 to 39 years compared with those aged 60 to 70 years, and 4.1 years longer in white adults aged 18 to 39 years compared with those aged 60 to 70 years.
The overall independent mediation effect of CKD in the context of risk difference in heart failure between Black adults and white adults was 54% in the 18-to-39-year age group, 40% in the 40-to-49-year age group, 41% in the 50-to-59-year age group and 91% in the 60-to-70-year age group. The mediation effect of heart failure in the context of risk difference in CKD between the two ethnicities was 13% in adults aged 18 to 39 years, 39% in those aged 40 to 49 years, 35% in adults aged 50 to 59 years and 15% in those aged 60 to 70 years.
“Both CKD and heart failure were apparent in some individuals within a few years of a type 2 diabetes diagnosis, even among those diagnosed at age < 40 years and particularly within the African American population,” the researchers wrote. “An urgent need exists to incorporate multidisciplinary care in the identification of high-risk patients from type 2 diabetes onset, along with legislative support promoting equitable access to therapies and care, especially for young, vulnerable and underrepresented patient populations.”
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