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Research Article
Volume 6 Issue 2 - 2021
The Prevalence of Cardiovascular Disease and Other Comorbidities Among American Indian and Alaska Native Adults with Diabetes
Joan M O’Connell1*, Jennifer E Rockell1,5, Judith C Ouellet1,6, Sherri Yoder2, Kimberly E Lind1,7, Charlton Wilson3, Andrew Friedson4 and Spero M Manson1
1Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
2Retired from the Indian Health Service, USA
3Chief Medical Officer, Mercy Care, Phoenix, AZ, USA
4Department of Economics, University of Colorado Denver, Denver, Colorado, USA
5Telligen, 7730 E Belleview Ave, Suite 300, Greenwood Village, CO, USA
6Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
7Mel & Enid Zuckerman College of Public Health, University of Arizona, USA
*Corresponding Author: Joan M O’Connell, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Received: December 29, 2021; Published: January 27, 2021




Abstract

Aims: American Indians and Alaska Native (AI/ANs) peoples experience significant health disparities compared to the U.S. general population. We report comorbidities among AI/ANs with diabetes to guide efforts to improve their health status.

Methods: Drawing upon data for over 640,000 AI/ANs who used services funded by the Indian Health Service, we identified 43,518 adults with diabetes in fiscal year 2010. We reported the prevalence of comorbidities by age and cardiovascular disease (CVD) status. Generalized linear models were estimated to describe associations between CVD and other comorbidities.

Results: Nearly 15% of AI/AN adults had diabetes. Hypertension, CVD and kidney disease were comorbid in 77.9%, 31.6%, and 13.3%, respectively. Nearly 25% exhibited a mental health disorder; 5.7%, an alcohol or drug use disorder. Among AI/ANs with diabetes absent CVD, 46.9% had 2 or more other chronic conditions; the percentage among adults with diabetes and CVD was 75.5%. Hypertension and tobacco use disorders were associated with a 71% (95% CI for prevalence ratio: 1.63 - 1.80) and 33% (1.28 - 1.37) higher prevalence of CVD, respectively, compared to adults without these conditions.

Conclusion: Detailed information on the morbidity burden of AI/ANs with diabetes may inform enhancements to strategies implemented to prevent and treat CVD and other comorbidities.

Keywords: American Indians; Alaska Natives; Diabetes; Cardiovascular Disease; Mental Health Disorders; Kidney Disease

References

  1. Centers for Disease Control and Prevention. “National Diabetes Statistics Report, 2017”. Atlanta, GA: U.S. Dept of Health and Human Services (2017).
  2. Espey DK., et al. “Leading causes of death and all-cause mortality in American Indians and Alaska Natives”. American Journal of Public Health S3 (2014): S303-S311.
  3. Barnes PM., et al. “Health characteristics of the American Indian and Alaska Native adult population: United States, 1999-2003. Rockville, MD: U.S. Dept of Health and Human Services, National Center for Health Statistics (2005).
  4. Indian Health Service, Special Diabetes Program for Indians. 2014 Report to Congress. Changing the course of diabetes: Turning hope into reality (2014).
  5. LeBeau M., et al. “The burden of diabetes among American Indians and Alaska Native Medicare enrollees. Rockville, MD: Dept of Health and Human Services, Centers for Medicare and Medicaid Services, Tribal Technical Advisory Group Data Project Data Brief (2015).
  6. Acton KJ., et al. “Diabetes prevalence among American Indians and Alaska Natives and the overall population - United States, 1994-2002”. Morbidity and Mortality Weekly Report 30 (2003): 702-704.
  7. Howard BV., et al. “Rising tide of cardiovascular disease in American Indians. The Strong Heart Study”. Circulation18 (1999): 2389-2395.
  8. O'Connell J., et al. “Racial disparities in health status: A comparison of the morbidity among American Indian and U.S. adults with diabetes”. Diabetes Care 33 (2010): 1-8.
  9. Bullock A., et al. “Vital Signs: Decrease in incidence of diabetes-related end-stage renal disease among American Indians/Alaska Natives - United States, 1996-2013”. Morbidity and Mortality Weekly Report 1 (2017): 26-32.
  10. Cho P., et al. “Diabetes-related mortality among American Indians and Alaska Natives, 1990–2009”. American Journal of Public Health S3 (2014): S496-S503.
  11. Veazie M., et al. “Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990–2009”. American Journal of Public Health S3 (2014): S359-S367.
  12. Schieb LJ., et al. “Trends and disparities in stroke mortality by region for American Indians and Alaska Natives”. American Journal of Public Health S3 (2014): S368-S376.
  13. Warne D and Frizzell LB. “American Indian health policy: Historical trends and contemporary issues”. American Journal of Public Health 3 (2014): S263-S267.
  14. S. Department of Health and Human Services, Indian Health Service”. IHS Profile based on 2015-2019 data (2020).
  15. S. Department of Health and Human Services, Indian Health Service”. IHS Profile based on 2015-2019 data (2020).
  16. Sequist TD., et al. “Indian Health Service innovations have helped reduce health disparities affecting American Indian and Alaska Native people”. Health Affairs 10 (2011): 1965-1973.
  17. S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. National health expenditure data (2020).
  18. United States Government Accountability Office. Report to the Committee on Indian Affairs, U.S. Senate: Indian Health Service. Actions needed to improve oversight of patient wait times. Washington, DC, Published (2016).
  19. O'Connell J., et al. “ARRA ACTION: Comparative effectiveness of health care delivery systems for American Indians and Alaska Natives using enhanced data infrastructure: Final report. Rockville, MD: Agency for Healthcare Research and Quality; Published (2014).
  20. Kunitz SJ. “Ethics in public health research: Changing patterns of mortality among American Indians”. American Journal of Public Health 3 (2008): 404-411.
  21. Roubideaux Y. “Beyond Red Lake: The persistent crisis in American Indian health care”. The New England Journal of Medicine 18 (2005): 1881-1883.
  22. S. Census Bureau. American Indian and Alaska Native Heritage Month: November 2011. Profile America Facts for Features (2011).
  23. Wang CCL., et al. “Clinical Update: Cardiovascular disease in diabetes mellitus, Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus – Mechanisms, management, and clinical considerations”. Circulation24 (2016): 2459-2502.
  24. American Diabetes Association. 8. Cardiovascular Disease and Risk Management”. Diabetes Care 39 (2016): S60-S71.
  25. O'Connell JM., et al. “The costs of treating American Indian adults with diabetes within the Indian Health Service”. American Journal of Public Health 2 (2012): 301-308.
  26. O'Connell J., et al. “Disparities in potentially preventable hospitalizations between American Indian and Alaska Native and Non-Hispanic White Medicare enrollees”. Medical Care6 (2017): 569-575.
  27. Moore K., et al. “Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: Results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project”. American Journal of Public Health 11 (2014): E158-E164.
  28. Manson SM., et al. “Special Diabetes Program for Indians: Retention in cardiovascular risk reduction”. The Gerontologist1 (2011): S21-S32.
  29. Rith-Najarian S., et al. “Preventing amputations from diabetes mellitus: The Indian Health Service experience”. West Indian Medical Journal 1 (2001): 41-43.
  30. Eichner JE., et al. “Tobacco use and cardiovascular disease among American Indians: The Strong Seart Study”. International Journal of Environmental Research and Public Health 10 (2010): 3816-3830.
  31. Verisk Health, Inc. Sightlines™ DxCG Risk Solutions”. Version 4.0.1. (2011).
  32. SAS software [computer program]. Version 9.4. Cary, NC, USA: SAS Institute, Inc (2013).
  33. McNutt LA., et al. “Estimating the relative risk in cohort studies and clinical trials of common outcomes”. American Journal of Epidemiology 10 (2013): 940-943.
  34. Zou G. “A modified poisson regression approach to prospective studies with binary data”. American Journal of Epidemiology 7 (2004): 702-706.
  35. Jiang L., et al. “Special Diabetes Program for Indians Healthy Heart Demonstration Project: Retention in cardiovascular risk reduction”. The Gerontologist1 (2011): S21-S32.
  36. Howard BV., et al. “Diabetes and coronary heart disease in American Indians: The Strong Heart Study”. Diabetes3 (1996): S6-13.
  37. Lee ET., et al. “Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years. The Strong Heart Study”. Diabetes Care5 (1995): 599-610.
  38. Lee JS., et al. “Triglyceride and HDL-C dyslipidemia and risks of coronary heart disease and ischemic stroke by glycemic dysregulation status: The Strong Heart Study”. Diabetes Care4 (2017): 529-537.
  39. Cholerton B., et al. “Total brain and hippocampal volumes and cognition in older American Indians: The Strong Heart Study”. Alzheimer Disease and Associated Disorders 2 (2017): 94-100.
  40. Leung MY., et al. “The burden of obesity on diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012”. Value Health1 (2017): 77-84.
  41. Nichols GA., et al. “Trends in diabetes incidence among 7 million insured adults, 2006-2011: the SUPREME-DM project”. American Journal of Epidemiology 1 (2015): 32-39.
  42. O'Connell J., et al. “Disparities in potentially preventable hospitalizations between American Indian and Alaska Native and non-Hispanic White Medicare enrollees”. Medical Care6 (2017): 569-575.
  43. Lloyd-Jones D., et al. “Heart disease and stroke statistics--2010 update: a report from the American Heart Association”. Circulation7 (2010): e46-e215.
  44. Go AS., et al. “Heart disease and stroke statistics--2014 update: a report from the American Heart Association”. Circulation3 (2014): e28-e292.
  45. Centers for Disease Control and Prevention. Health status of American Indians compared with other racial/ethnic minority populations--selected states, 2001-2002”. Morbidity and Mortality Weekly Report 52 (2003): 1148-1152.
  46. Maas AH and Appelman YE. “Gender differences in coronary heart disease”. Netherlands Heart Journal 12 (2010): 598-602.
  47. Riddle MC. “Standards in medical care of diabetes - 2020. American Diabetes Association; 2020”. Diabetes Care1 (2020).
  48. Chima CC., et al. “Multimorbidity is associated with increased rates of depression in patients hospitalized with diabetes mellitus in the United States”. Journal of Diabetic Complications 11 (2017): 1571-1579.
  49. Piette JD and Kerr EA. “The impact of comorbid chronic conditions on diabetes care”. Diabetes Care3 (2006): 725-731.
  50. Beals J., et al. “Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: Mental health disparities in a national context”. The American Journal of Psychiatry 9 (2005): 1723-1732.
  51. O'Connell JM., et al. “Disparities in patterns of alcohol use among reservation-based and geographically dispersed American Indian populations”. Alcoholism: Clinical and Experimental Research 1 (2005): 107-116.
  52. Egede LE., et al. “Trends in costs of depression in adults with diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011”. Journal of General Internal Medicine 6 (2016): 615-622.
  53. Wallace K., et al. “. The humanistic and economic burden associated with anxiety and depression among adults with comorbid diabetes and hypertension”. Journal of Diabetes Research (2018): 1-9.
  54. Fisher L., et al. “REDEEM: A pragmatic trial to reduce diabetes distress”. Diabetes Care9 (2013): 2551.
  55. Huang Y., et al. “Collaborative care for patients with depression and diabetes mellitus: A systematic review and meta-analysis”. BMC Psychiatry1 (2013): 260.
  56. S. Census Bureau, U.S. Department of Commerce. American Community Survey, PUMS Data (2020).
  57. S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. Area Health Resource Files (AHRF), 2013-2014. Rockville, MD: U.S. Department of Health and Human Services; Published (2003).
  58. Centers for Medicare and Medicaid Services' Tribal Technical Advisory Group. 2013-2018 American Indian and Alaska Native Strategic Plan. Baltimore, MD: Centers for Medicare and Medicaid Services (2014).
  59. Indian Health Service, Division of Diabetes Treatment and Prevention. Diabetes standards of care and clinical practice resources (2020).
Citation: Joan M O’Connell., et al. “The Prevalence of Cardiovascular Disease and Other Comorbidities Among American Indian and Alaska Native Adults with Diabetes”. EC Endocrinology and Metabolic Research 6.2 (2021): 05-20.

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