Race-Ethnic Disparities in Cardiometabolic Risk Profiles among Stroke Survivors with Undiagnosed Diabetes and Prediabetes in the United States

Abstract

Background and purpose: Up to 25% of the U.S. population has undiagnosed diabetes. Diabetes and stroke both disproportionately afflict race/ethnic minorities. We assessed race/ethnic differences in the prevalence of undiagnosed diabetes, prediabetes, and cardiometabolic risk profiles among stroke survivors in the United States.

Methods: The prevalence of diabetes and prediabetes among adults (≥20 years) with a self-reported history of stroke was assessed using the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2010. Cardiometabolic risk factors across race/ethnic groups were compared using linear and logistic regression before and after adjusting for covariates.

Results: From 1999 to 2010, 1070 individuals who participated in NHANES had a self-reported history of stroke. Among stroke survivors without a formal diagnosis of diabetes and prediabetes, 233 (32%) had undiagnosed prediabetes and 27 (3.7%) had undiagnosed diabetes. The prevalence of undiagnosed diabetes and prediabetes was the highest among non-Hispanic (NH) blacks (8% and 38%) compared with Mexican Americans (4% and 26%) and NH whites (3% and 32%). Compared with NH whites, NH blacks were significantly younger, more likely to take antihypertensive medications, more likely to smoke, and have poorly controlled diabetes. NH blacks were twice as likely as NH whites to have poorly controlled blood pressure, after adjustment for sociodemographic and vascular risk factors.

Conclusion: In the United States, NH black stroke survivors have the highest rates of undiagnosed diabetes and prediabetes, and have poorer cardiometabolic risk factor control than their NH white counterparts.

Keywords: Diabetes; cardiometabolic; dyslipidemia; hypertension; prediabetes; risk factor; stroke.