The co-existence of diabetes and subclinical atherosclerosis in rural central Appalachia: Do residential characteristics matter?

• Published in: Journal of diabetes and its complications 2021-04, Vol.35 (4), p.107851-107851, Article 107851
• Main Authors: Mamudu, Hadii M., Jones, Antwan, Paul, Timir K., Osedeme, Fenose, Stewart, David, Alamian, Arsham, Wang, Liang, Orimaye, Sylvester, Bledsoe, James, Poole, Amy, Blackwell, Gerald, Budoff, Mathew
• Format: Article
• Language: English
• Subjects: Age; Appalachia; Appalachian Region - epidemiology; Atherosclerosis; Atherosclerosis - complications; Atherosclerosis - epidemiology; Body mass index; Cardiovascular disease; Cardiovascular Diseases; Chronic illnesses; Clinical practice guidelines; Coronary Artery Disease - complications; Coronary Artery Disease - epidemiology; Coronary vessels; Diabetes; Diabetes Mellitus - epidemiology; Economic conditions; Economic indicators; Economic statistics; Family medical history; Females; Food stamps; Heart rate; Humans; Hypertension; Male; Medical referrals; Population; Public assistance programs; Risk Factors; Tobacco; Unemployment; Variables
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2021.107851

Aim Disparities exist in cardiovascular diseases (CVD) and diabetes in the United States (U.S.) with Central Appalachia having disproportionate burden. This study examined prevalence and correlates of CVD risk-factors among patients with diabetes/subclinical atherosclerosis in Central Appalachia. During 2012–2016, 3000 patients from Central Appalachia were screened for subclinical atherosclerosis, using coronary artery calcium (CAC) scores; 419 participants had diabetes. Patients were categorized into four groups, with emphasis on those having subclinical atherosclerosis, CAC score ≥ 1. Descriptive statistics and multilevel multinomial logistic regression were conducted to identify CVD risk and spatial factors associated with co-existence of diabetes and subclinical atherosclerosis. Among participants, prevalence of CVD risk-factors ranged from 11.7% for current smokers to 69.2% for those with CVD family history. Average BMI was 29.8. Compared to patients with diabetes only, age [RR = 1.07; p ≤ 0.0001], being male [RR = 5.33; p ≤ 0.0001], having hypertension [RR = 2.37; p ≤ 0.05] and being a former smoker were associated with increased likelihood of having diabetes/subclinical atherosclerosis. At the zip-code level, unemployment rate [RR = 1.37; p ≤ 0.05] was significantly associated with having diabetes/subclinical atherosclerosis. Consistent with clinical guidelines, study results suggest the need to integrate CAC screening into primary care diabetes programs while addressing spatial issues that predispose patients to have diabetes/subclinical atherosclerosis. •About1 in 3 of the study participant had both diabetes and subclinical atherosclerosis.•Residential factors were associated with coexisting diabetes and subclinical atherosclerosis.•Geographic units are important when working with populations at risk for diabetes.