Racial Differences in the Association between Clinical Measures and Self-Reported Health Status in Bypass Angioplasty Revascularization Investigation Type 2 Diabetes (BARI 2D)

Risk factors for Type 2 diabetes and coronary artery disease (CAD) are more prevalent in Black non-Hispanic (B) compared to White NH (W) subjects. We investigated self-reported health status in B and W patients with diabetes and CAD using selected clinical variables. The BARI 2D randomized trial enrolled 2368 patients with Type 2 diabetes and documented coronary artery disease between 1999 and 2005 from six countries. B (n=333) and W (n=866) patients enrolled at U.S. clinical sites were analyzed (N=1199). The primary outcome was self-rated health status classified as “Excellent/Very Good/Good” versus “Fair/Poor.” A significantly larger proportion of B patients compared to W patients rated their health as “Fair/Poor” (60% vs. 41%; p<.001). This difference between races in self-rated health remained significant after adjusting for demographic and clinical factors (OR=1.64, p=0.002). Among W patients, numerous factors were independently associated with a Fair/Poor rating including lower education level (OR=0.57; p<.001), clinical history of congestive heart failure (OR=2.58; p<.001), renal dysfunction (OR=2.48; p=0.01) and hypoglycemia. Among B patients, these factors were not associated with self-rated health (p>.25) and the estimated effect sizes for these clinical factors were consistently weaker. Black BARI 2D patients were more likely to have Fair/Poor self-rated health; however, standard clinical risk factors were less strongly associated with self-rated health in the B population relative to the W population. Exploring the reasons for this weaker association may provide insight into the disparities in cardiovascular outcomes that persist between Black and White patients in America.