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Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population: The Pathways Study

Bessie A. Young^*,,, Wayne J. Katon, Michael Von Korff^||, Greg E. Simon^||, Elizabeth H. B. Lin^||, Paul S. Ciechanowski, Terry Bush^||, Malia Oliver^||, Evette J. Ludman^|| and Edward J. Boyko^*,

^* Division of General Internal Medicine, Department of Medicine, University of Washington, and Primary and Specialty Medical Care Service, Veterans Affairs Puget Sound Health Care System;
Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System;
Northwest Kidney Centers;
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine; and
^|| Center for Health Studies, Group Health Cooperative, Seattle, Washington

Address correspondence to: Dr. Bessie A. Young, VA Puget Sound Health Care System (152-E), Epidemiologic Research and Information Center, 1660 S. Columbian Way, Seattle, WA 98108. Phone: 206-277-3586; Fax: 206-764-2563; E-mail: youngb{at}u.washington.edu

The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry–identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673