保険有者集団における糖尿病合併症における民族的差異
Andrew J Karter1, Assiamira Ferrara, Jennifer Y Liu
1Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA. Andy.J.Karter@kp.org
JAMA
|May 22, 2002
まとめ
糖尿病の合併症における民族的格差は依然として存在し,少数民族は末期腎疾患 (ESRD) の割合が高く,しかし,白人と比べて心臓筋梗塞 (MI),脳卒中,心不全 (CHF),下肢切断 (LEA) のリスクは同じまたは低い.
科学分野:
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
- 健康の格差について
背景:
- マイノリティの人口は,しばしばマイクロ血管合併症のより高い割合を示します.
- 医療へのアクセスにおける格差は,糖尿病の合併症率における民族的差異の原因としてしばしば挙げられる.
- 一貫した保健医療の範囲を持つ多様な人口を研究することで,これらの格差を明らかにすることができます.
研究 の 目的:
- 糖尿病合併症の発生率における民族的差異を調査する.
- 非営利のプリペイド医療システムにおけるこれらの格差を分析する.
主な方法:
- 縦断的な観察研究が1995年から1998年に実施されました.
- この研究では,多様な民族 (アジア人,黒人,ラテン系,白人) の糖尿病患者62,432人が参加しました.
- 主なアウトカムには,心筋梗塞 (MI),脳卒中,心不全 (CHF),下肢切断 (LEA),末期腎疾患 (ESRD) が含まれていた.
主要な成果:
- 合併症率における民族的差異は矛盾しており,人口統計的,社会経済的,行動的,および臨床的要因を調整した後もしばしば持続していた.
- マイノリティーグループ,特に黒人とアジア人は,末期腎疾患 (ESRD) の調整された危険比率を大幅に高めた.
- 対照的に,アジア系およびラテン系の人々は,白人と比較して,心筋梗塞 (MI),脳卒中,心不全 (CHF),下肢切断 (LEA) の調整された危険比率が低い.
結論:
- この研究は,統一された医療制度にもかかわらず,少数民族の末期性腎疾患 (ESRD) の発生率が高いことを確認しています.
- 新しい証拠は,他の糖尿病合併症が白人と比較してマイノリティーで同様のまたは低い割合で発生することを示唆しています.
- 格差の持続は,潜在的な遺伝的要因,測定されていない環境影響,またはそれらの組み合わせを示唆しています.
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