Ethnic Disparities in Diabetes Complications

描述（由申请人提供）：本提案的广泛、长期目标是在Kaiser Permanente （KP）的综合管理式医疗环境中，评估非洲裔美国人、亚洲人、高加索人、菲律宾人和拉丁美洲人等大量特征明确的人群中糖尿病并发症发生率和前因的种族差异。该研究将侧重于糖尿病并发症的卫生服务和流行病学方面，包括心肌梗死、中风、充血性心力衰竭、终末期肾病、下肢截肢和增殖性视网膜病变。糖尿病并发症的差异有充分的文献记载。该研究人员先前报告了KP糖尿病成员的并发症发生率的种族差异，但模式不一致，尽管有统一的健康覆盖（附录A）。下一步将是确定因种族而异的可改变因素，从而可能有助于解释观察到的差异。如果这些风险因素在不同种族的患病率和/或效应大小上有所不同，它们可以解释部分种族差异和并发症发生率不一致的模式。我们建议对来自5个最大的民族的大约2万名糖尿病患者进行调查和前瞻性随访，以收集有关潜在的解释性、可改变的风险因素（临床、社会经济、行为、社会心理）的丰富信息来源。这些因素可以作为适当的干预目标，旨在减少并发症的种族差异。次要目标包括

DESCRIPTION (provided by applicant): The broad, long-term objective of this proposal is to evaluate ethnic differences in the incidence and antecedents of diabetic complications in a large, well-characterized population of African Americans, Asians, Caucasians, Filipinos, and Latinos within an integrated, managed care setting Kaiser Permanente (KP). The study will focus on health services and epidemiologic aspects of diabetic complications including myocardial infarction, stroke, congestive heart failure, end-stage renal disease, lower-extremity amputation and proliferative retinopathy. Disparities in the complications of diabetes are well documented. This investigator previously reported findings of ethnic disparities, but with inconsistent patterns, in rates of complications among diabetic members of KP, despite uniform health coverage (Appendix A). The next step will be to identify modifiable factors that differ by ethnicity and may therefore help to explain observed disparities. If such risk factors differ either in prevalence and/or effect size across ethnic groups, they may explain a portion of the ethnic disparities and inconsistent patterns of rates of complications. We propose to survey and prospectively follow approximately 20,000 diabetic patients, with equal representation from the 5 largest ethnic groups, to collect a rich source of information regarding potentially explanatory, modifiable risk factors (clinical, socioeconomic, behavioral, psychosocial). These factors could serve as appropriate targets for interventions aiming to reduce ethnic disparities in complications. Secondary aims include evaluating ethnic differences in i) the association between the quality of the patient-provider relationship and patient adherence; ii) access to appropriate specialty care and rates of standard processes of care; iii) the incidence of complications among smaller, rarely studied ethnic groups (Native Americans, Pacific Islanders and South Asians); and iv) rates of diffusion of newly introduced preventive health innovations. Secondary aims 5 and 6 will be based on a pre-existing cohort in an ongoing longitudinal study of approximately 78,000 respondents to a survey initiated in 1994 (83% response rate). By studying a population with uniform health coverage, this study will complement extant national surveillance and population-based studies that include patients with varying levels of medical coverage. These latter studies are less able to disentangle the confounding effect of ethnic disparities in health care access and quality. Further characterizing ethnic disparities in the incidence of complications in a contemporary, insured population with diabetes and identifying key modifiable factors that can be the focus of targeted interventions will have public health and scientific value.