Diabetes Incidence Based on Linkages With Health Plans: The Multiethnic Cohort

  1. Gertraud Maskarinec1,
  2. Eva Erber1,
  3. Andrew Grandinetti2,
  4. Martijn Verheus1,
  5. Robert Oum1,
  6. Beth N. Hopping1,
  7. Mark M. Schmidt3,
  8. Aileen Uchida3,
  9. Deborah Taira Juarez2,4,
  10. Krista Hodges4 and
  11. Laurence N. Kolonel1
  1. 1Cancer Research Center, University of Hawaii, Honolulu, Hawaii;
  2. 2Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii;
  3. 3Kaiser Permanente Center for Health Research, Honolulu, Hawaii;
  4. 4Hawaii Medical Service Association, Blue Cross Blue Shield of Hawaii, Honolulu, Hawaii.
  1. Corresponding author: Gertraud Maskarinec, gertraud{at}crch.hawaii.edu.

Abstract

OBJECTIVE Using the Hawaii component of the Multiethnic Cohort (MEC), we estimated diabetes incidence among Caucasians, Japanese Americans, and Native Hawaiians.

RESEARCH DESIGN AND METHODS After excluding subjects who reported diabetes at baseline or had missing values, 93,860 cohort members were part of this analysis. New case subjects were identified through a follow-up questionnaire (1999–2000), a medication questionnaire (2003–2006), and linkage with two major health plans (2007). We computed age-standardized incidence rates and estimated hazard ratios (HRs) for ethnicity, BMI, education, and combined effects of these variables using Cox regression analysis.

RESULTS After a total follow-up time of 1,119,224 person-years, 11,838 incident diabetic case subjects were identified with an annual incidence rate of 10.4 per 1,000 person-years. Native Hawaiians had the highest rate with 15.5, followed by Japanese Americans with 12.5, and Caucasians with 5.8 per 1,000 person-years; the adjusted HRs were 2.65 for Japanese Americans and 1.93 for Native Hawaiians. BMI was positively related to incidence in all ethnic groups. Compared with the lowest category, the respective HRs for BMIs of 22.0–24.9, 25.0–29.9, and ≥30.0 kg/m2 were 2.10, 4.12, and 9.48. However, the risk was highest for Japanese Americans and intermediate for Native Hawaiians in each BMI category. Educational achievement showed an inverse association with diabetes risk, but the protective effect was limited to Caucasians.

CONCLUSIONS Within this multiethnic population, diabetes incidence was twofold higher in Japanese Americans and Native Hawaiians than in Caucasians. The significant interaction of ethnicity with BMI and education suggests ethnic differences in diabetes etiology.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received December 4, 2008.
    • Accepted February 23, 2009.

  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Published online before print March 3, 2009, doi: 10.2337/db08-1685 Diabetes August 2009 vol. 58 no. 8 1732-1738
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