Risk factors for heart disease and stroke among diabetic persons, by disability status

Abstract

Objective

To determine whether disabled diabetic persons have a higher prevalence of risk factors for heart disease and stroke than do diabetic persons without disability.

Research, design, and methods

Data were analyzed for noninstitutionalized adults in 27 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 and/or 2003. Logistic regression analysis was used to estimate the adjusted prevalence and odds ratios of disabled diabetic persons, by sociodemographic characteristics. The logit form of each model was used to estimate conditional marginal probabilities of risk factors for heart disease and stroke among diabetic persons, by disability status.

Results

Diabetic persons with disability were more likely than those without disability to have more risk factors for heart disease and stroke, including insufficient leisure-time physical activity or inactivity (adjusted prevalence: 75.2% vs. 63.3%; P<.001), obesity (58.9% vs. 43.3%; P<.001), hypercholesterolemia (52.6% vs. 48.4%; P=.038), and hypertension (63.9% vs. 56.6%; P<.001). They were also more likely to have one or more, two or more, three or more, and four or more risk factors (97.2% vs. 95.6%, 83.5% vs. 74.0%, 56.5% vs. 41.1%, and 22.2% vs. 13.6%, respectively; P≤.005).

Conclusions

Diabetic persons with disability are more likely than those without disability to have clusters of risk factors for heart disease and stroke. Health care guidelines specifically targeting diabetic patients with disability may be needed to aid health care providers in addressing these risk factors.

Introduction

Heart disease and stoke are leading causes of diabetes-related deaths among U.S. adults (Wingard & Barrett-Connor, 1995, Geiss et al., 1995). Adults with diabetes have death rates from heart disease that are about two to four times higher than those of adults without diabetes, and their risk for stroke is also two to four times higher (Centers for Disease Control and Prevention, 2004a). An estimated 77% of diabetes-related hospitalizations are due to heart disease and stroke (Wingard & Barrett-Connor, 1995), and survival after myocardial infarction is worse for persons with diabetes (Sprafka, Burke, Folsom, McGovern, & Hahn, 1991). Furthermore, the risk of sudden death from heart attack in persons with diabetes without known heart disease is as high as the rate seen in nondiabetic persons with a history of this condition (Mooradian, 2003). The high prevalence of undiagnosed heart disease and stroke among persons with diabetes and the seriousness of cardiovascular events in this population is worrying in that almost 70% of persons with diabetes do not realize their increased risk of a life-threatening complication (Mooradian, 2003).

Persons with diabetes are also at increased risk of disability because of the high prevalence of complication and comorbidities (Gregg et al., 2000, Gregg et al., 2000, Ryerson et al., 2003, Saaddine et al., 1999, Songer, 1995, Volpato et al., 2003). Comorbidities commonly involved in the disablement process, such as heart disease and stroke, vision loss, physical impairment, cognitive impairment, peripheral neuropathy, and overweight, are more prevalent in diabetic persons than in persons without this disease (Gregg et al., 2000, Gregg et al., 2000, Ryerson et al., 2003, Saaddine et al., 1999, Songer, 1995, Volpato et al., 2003). Notably, more than 39% of persons with diabetes report being limited in their major activity [i.e., working at a job or business or keeping house for those aged 18–69 years; independent performance of activities of daily living (e.g., bathing, eating, and shopping) for those aged ≥70 years], and 23% report being unable to perform that activity (Centers for Disease Control and Prevention, 1999). The consequences of disability among persons with diabetes include the increased use of health care services, work absenteeism, unemployment, and decreased quality of life (Centers for Disease Control and Prevention, 1999). Persons with diabetes also have a reduced life expectancy and fewer years of active life (Jagger, Goyder, Clarke, Brouard, & Arthur, 2003).

In this study, we used data from the 2001 and 2003 Behavioral Risk Factor Surveillance System (BRFSS) to assess whether diabetic persons with disability were more likely than diabetic persons without disability to have individual risk factors or clusters of risk factors for heart disease and stroke.