Elsevier

Annals of Epidemiology

Volume 25, Issue 9, September 2015, Pages 649-655
Annals of Epidemiology

Original article
Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes

https://doi.org/10.1016/j.annepidem.2015.04.006Get rights and content

Abstract

Purpose

The study objective was to examine the role of physical activity (PA) and sedentary time (ST) on mortality risk among a population of low-income adults with diabetes.

Methods

Black (n = 11,137) and white (n = 4508) men and women with diabetes from the Southern Community Cohort Study self-reported total PA levels and total ST. Participants were categorized into quartiles of total PA and total ST. Hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent mortality risk were estimated from Cox proportional hazards analysis with adjustment for potential confounders.

Results

During follow-up, 2370 participants died. The multivariable risk of mortality was lower among participants in the highest quartile of PA compared with those in the lowest quartile (HR, 0.64; 95% CI: 0.57–0.73). Mortality risk was significantly increased among participants in the highest compared with the lowest quartile of ST after adjusting for PA (HR, 1.21; 95% CI: 1.08–1.37). Across sex and race groups, similar trends of decreasing mortality with rising PA and increasing mortality with rising ST were observed.

Conclusions

Although causality cannot be established from these observational data, the current findings suggest that increasing PA and decreasing ST may help extend survival among individuals with diabetes irrespective of race and sex.

Section snippets

Methods

Subjects for this study were participants in the SCCS, an ongoing, prospective cohort study designed to examine health disparities in the incidence and mortality of chronic illnesses. Details of study methods are provided elsewhere [9], [10], [11]; in brief, study participants were 40–79 years of age at enrollment and recruited from community health centers (85%) and general population mailings (15%) across a 12-state area of the southeastern United States (Alabama, Arkansas, Florida, Georgia,

Results

The 15,645 SCCS participants with diabetes (71.2% black, 28.8% white, and 65.0% female) had an average age at enrollment of 54.9 (8.9) years (Table 1). Approximately two-thirds of the population had a high school education or less, and more than 60% reported an annual household income of less than $15,000. Females were significantly more likely to report an annual household income of less than $15,000. Blacks were slightly younger than whites at both their time of enrollment and time of

Conclusions

In this prospective analysis of a racially diverse, low-income population with diabetes, we found that higher levels of total PA were associated with a 36% reduced risk of mortality after adjusting for ST. Increased total time spent in sedentary behaviors was linked to an approximate 21% increase in mortality risk in this population after adjusting for PA. Furthermore, the analysis of the joint associations of both PA and ST on mortality risk revealed that across all levels of ST, low levels of

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