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Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus

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Abstract

Background

Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes.

Methods

We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates.

Results

Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients.

Conclusion

Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.

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Acknowledgements

This study was supported by Grant # REA 08–261, Center for Disease Prevention and Health Interventions for Diverse Populations funded by Veterans Affairs Health Services Research and Development (PI – Leonard Egede).

Conflict of Interest

None of the authors have any financial disclosure or conflict of interest to report.

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Authors and Affiliations

  1. Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Charleston, SC, USA

    R. Neal Axon MD, MSCR, Mulugeta Gebregziabher PhD, Carrae Echols MS, Gregory Gilbert MSPH & Leonard E. Egede MD, MS

  2. Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA

    R. Neal Axon MD, MSCR & Leonard E. Egede MD, MS

  3. Division of Biostatistics, and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Mulugeta Gebregziabher PhD

  4. Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, P.O. Box 250593, Charleston, SC, 29425-0593, USA

    Leonard E. Egede MD, MS

Authors
  1. R. Neal Axon MD, MSCR
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  2. Mulugeta Gebregziabher PhD
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  3. Carrae Echols MS
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  5. Leonard E. Egede MD, MS
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Correspondence to Leonard E. Egede MD, MS.

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Axon, R.N., Gebregziabher, M., Echols, C. et al. Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus. J GEN INTERN MED 26, 1278–1283 (2011). https://doi.org/10.1007/s11606-011-1752-3

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  • DOI: https://doi.org/10.1007/s11606-011-1752-3

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