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Original Research |

Associations Between Trends in Race/Ethnicity, Aging, and Body Mass Index With Diabetes Prevalence in the United States: A Series of Cross-sectional StudiesIncrease in Diabetes Prevalence Over Time

Andy Menke, PhD; Keith F. Rust, PhD; Judith Fradkin, MD; Yiling J. Cheng, PhD; and Catherine C. Cowie, PhD
[+] Article and Author Information

From Social & Scientific Systems, Silver Spring, Maryland; Westat, Rockville, Maryland; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute of Diabetes and Digestive and Kidney Diseases or the Centers for Disease Control and Prevention.

Grant Support: By a contract from the National Institute of Diabetes and Digestive and Kidney Diseases (GS10F0381L; Dr. Menke).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0286.

Reproducible Research Statement:Study protocol: Available at www.cdc.gov/nchs/nhanes/about_nhanes.htm. Statistical code: Available from Dr. Menke (e-mail, amenke@s-3.com). Data set: Available at www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm.

Requests for Single Reprints: Andy Menke, PhD, Social & Scientific Systems, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910; e-mail, amenke@s-3.com.

Current Author Addresses: Dr. Menke: Social & Scientific Systems, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910.

Dr. Rust: Westat, 1650 Research Boulevard, Rockville, MD 20850.

Dr. Fradkin: National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Boulevard, Room 683, Bethesda, MD 20892.

Dr. Cheng: Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-10, Atlanta, GA 30341.

Dr. Cowie: National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Boulevard, Room 691, Bethesda, MD 20892.

Author Contributions: Conception and design: A. Menke, J. Fradkin, C.C. Cowie.

Analysis and interpretation of the data: A. Menke, K.F. Rust, J. Fradkin, C.C. Cowie.

Drafting of the article: A. Menke.

Critical revision of the article for important intellectual content: K.F. Rust, J. Fradkin, Y.J. Cheng, C.C. Cowie.

Final approval of the article: A. Menke, K.F. Rust, Y.J. Cheng, C.C. Cowie.

Statistical expertise: K.F. Rust, Y.J. Cheng, C.C. Cowie.

Obtaining of funding: C.C. Cowie.

Administrative, technical, or logistic support: C.C. Cowie.


Ann Intern Med. 2014;161(5):328-335. doi:10.7326/M14-0286
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Background: The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence.

Objective: To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults.

Design: Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976–1980), NHANES III (1988–1994), and the continuous NHANES 1999–2002, 2003–2006, and 2007–2010.

Setting: Nationally representative samples of the U.S. noninstitutionalized civilian population.

Patients: 23 932 participants aged 20 to 74 years.

Measurements: Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more.

Results: Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend = 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment.

Limitation: Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys.

Conclusion: The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women.

Primary Funding Source: Centers for Disease Control and Prevention and National Institutes of Diabetes and Digestive and Kidney Diseases.

Figures

Grahic Jump Location
Figure 1.

Crude and unadjusted prevalence of diabetes in men and women, 1976–2010.

Points refer to crude prevalence, and lines refer to unadjusted prevalence (logistic regression–based).

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Grahic Jump Location
Figure 2.

Crude and adjusted prevalence of diabetes in men and women, 1976–2010.

Adjustment included age, race/ethnicity, and body mass index. Error bars represent 95% CIs.

Grahic Jump Location

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