The Long-Term Risks of End Stage Renal Disease and Mortality among First Nations and Non-First Nations People with Youth-Onset Diabetes

Abstract Objective To compare the long-term risks of end stage renal disease and death among First Nations and non-First Nations people with youth-onset diabetes. Methods Using Saskatchewan Ministry of Health administrative databases covering the period between 1980 and 2005, we conducted a retrospe...

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Bibliographic Details
Published in:Canadian journal of diabetes 2014-08, Vol.38 (4), p.237-243
Main Authors: Dyck, Roland F., MD, Jiang, Ying, MSc, Osgood, Nathaniel D., PhD
Format: Article
Language:English
Subjects:
Adolescent
canada
Child
Cohort Studies
Diabetes Mellitus, Type 2 - complications
diabète juvénile
disparities
disparités
end stage renal disease
Endocrinology & Metabolism
epidemiology
First Nations
Humans
Indians, North American
indigenous
indigène
insuffisance rénale terminale
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - mortality
mortality
mortalité
Multivariate Analysis
Other
Premières Nations
Prevalence
Retrospective Studies
Risk Assessment - methods
Saskatchewan - epidemiology
youth-onset diabetes
épidémiologie
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Summary:Abstract Objective To compare the long-term risks of end stage renal disease and death among First Nations and non-First Nations people with youth-onset diabetes. Methods Using Saskatchewan Ministry of Health administrative databases covering the period between 1980 and 2005, we conducted a retrospective cohort study of end stage renal disease and death among youth with diabetes diagnosed before age 20. We developed Fine and Gray sub-distribution hazards models and cumulative incidence functions for the 2 outcomes by First Nations status and duration of diabetes. Results Incident cases of youth-onset diabetes were diagnosed in 352 First Nations and 2288 non-First Nations people. Mean ages at diabetes diagnoses were 11.7 and 11.2 years, respectively (p=0.13). Adjusted for sex and age at diabetes diagnosis, the risk for end stage renal disease was 2.59 (95% CI, 1.11–6.04) times higher, and the risk for death 2.64 (95% CI, 1.44–4.87) times higher for First Nations compared to non-First Nations people. After 25 years, the cumulative incidence of end stage renal disease was 12.3% for First Nations people compared to 4.3% in their non-First Nations counterparts. Corresponding mortality rates were 14.6% and 7.2%, respectively. Conclusions First Nations people with youth-onset diabetes experience higher long-term risks for end stage renal disease and death than their non-First Nations counterparts. Early identification of type 2 diabetes and secondary prevention of diabetic nephropathy are feasible short-term goals for this high-risk group. More effective primary prevention initiatives and programs to delay diabetes onset are imperative to reverse current trends.
ISSN:1499-2671
2352-3840
DOI:10.1016/j.jcjd.2014.03.005