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. 2020 Dec 4;10(12):e039489.
doi: 10.1136/bmjopen-2020-039489.

US veterans administration diabetes risk (VADR) national cohort: cohort profile

Sanja Avramovic  1   2 , Farrokh Alemi  3 , Rania Kanchi  4 , Priscilla M Lopez  4 , Richard B Hayes  4 , Lorna E Thorpe  4 , Mark D Schwartz  2   4
Affiliations

US veterans administration diabetes risk (VADR) national cohort: cohort profile

Sanja Avramovic et al. BMJ Open. .

Abstract

Purpose: The veterans administration diabetes risk (VADR) cohort facilitates studies on temporal and geographic patterns of pre-diabetes and diabetes, as well as targeted studies of their predictors. The cohort provides an infrastructure for examination of novel individual and community-level risk factors for diabetes and their consequences among veterans. This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans.

Participants: The VADR cohort includes all 6 082 018 veterans in the USA enrolled in the veteran administration (VA) for primary care who were diabetes-free as of 1 January 2008 and who had at least two diabetes-free visits to a VA primary care service at least 30 days apart within any 5-year period since 1 January 2003, or veterans subsequently enrolled and were diabetes-free at cohort entry through 31 December 2016. Cohort subjects were followed from the date of cohort entry until censure defined as date of incident diabetes, loss to follow-up of 2 years, death or until 31 December 2018.

Findings to date: The incidence rate of type 2 diabetes in this cohort of over 6 million veterans followed for a median of 5.5 years (over 35 million person-years (PY)) was 26 per 1000 PY. During the study period, 8.5% of the cohort were lost to follow-up and 17.7% died. Many demographic, comorbidity and other clinical variables were more prevalent among patients with incident diabetes.

Future plans: This cohort will be used to study community-level risk factors for diabetes, such as attributes of the food environment and neighbourhood socioeconomic status via geospatial linkage to residence address information.

Keywords: epidemiology; general diabetes; health informatics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cohort flow diagram of diabetes-free cohort of US veterans, 2008–2016. EHR, electronic health record; LFU, lost to follow-up; VA, veterans administration.
Figure 2
Figure 2
Cohort trends, with cumulative numbers and percentage of patients, 2008 through 2018. PY, person-years.
Figure 3
Figure 3
Geographic distribution of VADR cohort. VADR, veterans administration diabetes risk.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention Estimates of diabetes and its burden in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017.
    1. Centers for Disease Control and Prevention Underlying cause of death 1999-2008. National Center for Health Statistics, 2018.
    1. American Diabetes Association Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033–46. 10.2337/dc12-2625 - DOI - PMC - PubMed
    1. Prevention CfDCa Diabetes quick facts, 2019. Available: https://www.cdc.gov/diabetes/basics/quick-facts.html [Accessed 27 Feb 2020].
    1. Veterans Health Administration VA research on diabetes, 2019.

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