Analysis on Comorbidity of CVD and Diabetes and Their Risk Factors

BACKGROUND: Comorbidity has been reported between Cardiovascular Disease (CVD) and Diabetes, while extent, correlates, and impacts from individual or shared risk factors remain unclear. Analysis involving multiple chronic condition dependent variables and weighted procedures of large population-based surveys is lacking. METHODS: Self-reported information of clinically diagnosed CVD, diabetes, and risk factors was obtained from participants of 2009 U.S. nationwide Behavior Risk Factor Surveillance System (BRFSS). Bivariate survey logistic regression was applied to discern the outcome specific and overall risk factors and to test the correlation between multiple binary outcomes. The bivariate regression model was fitted in R 2.13.0. RESULTS: Of 303,805 participants, 35,859 CVD, 38,651 diabetes, and 10,567 with both CVD and diabetes were reported. A substantial comorbidity was found between CVD and diabetes (OR = 3.56, P<0.001; AOR=1.72, P<0.001 after controlling for demographic characteristics). Risk factors associated with both CVD and diabetes were increased age, male gender, lower income, previous smoker, hypertension and elevated cholesterol. When comparing the impacts of risk factors between CVD and diabetes, Native American race, male, current or previous smoker, and elevated cholesterol were more significantly attributed to CVD, while Black, Asian or Hispanic race, overweight BMI and higher education attributed more significantly to diabetes compared to CVD. CONCLUSION: We found significant comorbidity in those diagnosed with CVD or diabetes; although some risk factors were associated with both CVD and diabetes, their contributions to CVD or diabetes may be significantly different.