Racial Differences in the Association between Clinical Measures and Self-Reported Health Status in Bypass Angioplasty Revascularization Investigation Type 2 Diabetes (BARI 2D)
By MELISSA MEINZERPolitics Policy & Public Health
November 7, 2007
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Veronica V. Sansing, BA1, Stephen B. Thomas, PhD2, Andrew M. Davis, MD, MPH, FACP3, Michelle Magee, MD, CDE4, and Maria Mori Brooks, PhD1. (1) BARI 2D Coordinating Center, University of Pittsburgh, 130 DeSoto St., 127F Parran Hall, Pittsburgh, PA 15261, 4126247875, vsansing@cmh.pitt.edu, (2) Center for Minority Health, University of Pittsburgh School of Public Health, 127 Parran Hall, 130 Desoto Street, Pittsburgh, PA 15261, (3) Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 3051, Chicago, IL 60637, (4) MedStar Research Institute, Washington Hospital Center/Georgetown University Medical Center, 110 Irving St, NW EB4114, Washington, DC 20010-2933
Risk factors for Type 2 diabetes and coronary artery disease (CAD) are more prevalent in Black non-Hispanic (B) compared to White NH (W) subjects. We investigated self-reported health status in B and W patients with diabetes and CAD using selected clinical variables. The BARI 2D randomized trial enrolled 2368 patients with Type 2 diabetes and documented coronary artery disease between 1999 and 2005 from six countries. B (n=333) and W (n=866) patients enrolled at U.S. clinical sites were analyzed (N=1199). The primary outcome was self-rated health status classified as “Excellent/Very Good/Good” versus “Fair/Poor.” A significantly larger proportion of B patients compared to W patients rated their health as “Fair/Poor” (60% vs. 41%; p <.001). This difference between races in self-rated health remained significant after adjusting for demographic and clinical factors (OR=1.64, p=0.002). Among W patients, numerous factors were independently associated with a Fair/Poor rating including lower education level (OR=0.57; p<.001), clinical history of congestive heart failure (OR=2.58; p<.001), renal dysfunction (OR=2.48; p=0.01) and hypoglycemia. Among B patients, these factors were not associated with self-rated health (p>.25) and the estimated effect sizes for these clinical factors were consistently weaker. Black BARI 2D patients were more likely to have Fair/Poor self-rated health; however, standard clinical risk factors were less strongly associated with self-rated health in the B population relative to the W population. Exploring the reasons for this weaker association may provide insight into the disparities in cardiovascular outcomes that persist between Black and White patients in America.
Learning Objectives:
- In spite of a weaker association with cardiovascular disease risk factors for fair/poor health, Black patients significantly more frequently self-report health as fair/poor than White patients.
- Identify disparities between the factors that influence self reported health in Black and White patients with cardiovascular disease and Type 2 diabetes.
- Investigate additional factors such as health care attitudes in these racial groups and institutional policies that may enable to give insight into the reasons for disparities in cardiovascular outcomes that persist between Black and White patients in the United States.
Related Web page: www.bari2d.org
Presenting author's disclosure statement:
Any relevant financial relationships? No
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