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

• Published in: Canadian journal of diabetes Vol. 38; no. 4; pp. 237 - 243
• Main Authors: Dyck, Roland F., MD, Jiang, Ying, MSc, Osgood, Nathaniel D., PhD
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Inc 01.08.2014
• 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; Saskatchewan; disparities; indigène; disparités; mortalité; épidémiologie; youth-onset diabetes; end stage renal disease; epidemiology; First Nations; canada; insuffisance rénale terminale; diabète juvénile; indigenous; mortality; Premières Nations
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2014.03.005

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.