BMJ 1996;313:848-852 (5 October)

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Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study

Nish Chaturvedi, senior lecturer,a John Jarrett, professor,b Nick Morrish, consultant physician,c Harry Keen, professor,d John H Fuller, professor a

a Department of Epidemiology and Public Health, University College London, London WC1E 6BT, b London SE26 4PA, c South Wing, Bedford Hospital, Bedford MK42 9DJ, d Unit for Metabolic Medicine, Guy's Hospital, London SE1 9RT

Correspondence to: Dr Chaturvedi.

Abstract

Objective: To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans.
Design: Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1995.
Patients: 150 Europeans and 77 African Caribbeans with non-insulin dependent diabetes.
Main outcome measures: All cause and cardiovascular mortality; prevalence of microvascular and macrovascular complications.
Results: Duration of diabetes was shorter in African Caribbeans, particularly women. African Caribbeans were more likely than the Europeans to have been given a diagnosis after the onset of symptoms and less likely to be taking insulin. Mean cholesterol concentration was lower in African Caribbeans, but blood pressure and body mass index were not different in the two ethnic groups. Prevalence of microvascular and macrovascular complications was insignificantly lower in African Caribbeans than in Europeans. 59 Europeans and 16 African Caribbeans had died by the end of follow up. The risk ratio for all cause mortality was 0.41 (95% confidence interval 0.23 to 0.73) (P = 0.002) for African Caribbeans v Europeans. This was attenuated to 0.59 (0.32 to 1.10) (P = 0.1) after adjustment for sex, smoking, proteinuria, and body mass index. Further adjustment for systolic blood pressure, cholesterol concentration, age, duration of diabetes, and treatment made little difference to the risk ratio. Unadjusted risk ratios for cardiovascular and ischaemic heart disease were 0.33 (0.15 to 0.70) (P = 0.004) and 0.37 (0.16 to 0.85) (P = 0.02) respectively.
Conclusions: African Caribbeans with non-insulin dependent diabetes maintain a low risk of heart disease. Management priorities for diabetes developed in one ethnic group may not necessarily be applicable to other groups.

Key messages

  • People of black African descent worldwide have low rates of heart disease despite having high rates of diabetes

  • This study found that this protection from heart disease persists in people with diabetes: African Caribbeans with diabetes have a third of the risk of dying from heart disease compared with Europeans

  • Assumptions about risk factor relations derived from studies in European populations may not necessarily hold true for other ethnic groups

  • Establishing the reasons for this relative protection may further the understanding of heart disease and may provide valuable clues to help reduce the risk of heart disease in all populations


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