Non-traditional risk factors are important contributors to the racial disparity in diabetes risk: The atherosclerosis risk in communities study

Ranee Chatterjee, Frederick L. Brancati, Tariq Shafi, David Edelman, James S. Pankow, Thomas H. Mosley, Elizabeth Selvin, Hsin Chieh Yeh

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31 Scopus citations


BACKGROUND: Traditional risk factors, particularly obesity, do not completely explain the excess risk of diabetes among African Americans compared to whites. OBJECTIVE: We sought to quantify the impact of recently identified, non-traditional risk factors on the racial disparity in diabetes risk. DESIGN: Prospective cohort study. PARTICIPANTS: We analyzed data from 2,322 African-American and 8,840 white participants without diabetes at baseline from the Atherosclerosis Risk in Communities (ARIC) Study. MAIN MEASURES: We used Cox regression to quantify the association of incident diabetes by race over 9 years of in-person and 17 years of telephone follow-up, adjusting for traditional and non-traditional risk factors based on literature search. We calculated the mediation effect of a covariate as the percent change in the coefficient of race in multivariate models without and with the covariate of interest; 95 % confidence intervals (95 % CI) were calculated using boot-strapping. KEY RESULTS: African American race was independently associated with incident diabetes. Body mass index (BMI), forced vital capacity (FVC), systolic blood pressure, and serum potassium had the greatest explanatory effects for the difference in diabetes risk between races, with mediation effects (95 % CI) of 22.0 % (11.7 %, 42.2 %), 21.7 %(9.5 %, 43.1 %), 17.9 % (10.2 %, 37.4 %) and 17.7 % (8.2 %, 39.4 %), respectively, during 9 years of in-person follow-up, with continued effect over 17 years of telephone follow-up. CONCLUSIONS: Non-traditional risk factors, particularly FVC and serum potassium, are potential mediators of the association between race and diabetes risk. They should be studied further to verify their importance and to determine if they mark causal relationships that can be addressed to reduce the racial disparity in diabetes risk.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalJournal of general internal medicine
Issue number2
StatePublished - Feb 2014

Bibliographical note

Funding Information:
Funders: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN26 8201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Drs Yeh and Brancati were supported by a Dia betes Research & Training Center Grant from the NIDDK (P30 DK079637). Dr. Brancati was supported by a grant from the National Institutes of Health, NIDDK, Bethesda, MD (K24 DK62222).


  • diabetes
  • non-traditional risk factors
  • racial disparity


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