Mortality, All-Cause and Cardiovascular Disease, Over 15 Years in Multiethnic Mauritius

Abstract

OBJECTIVE Little information is available on the impact of abnormal glucose tolerance on mortality in South Asian and African populations in the developing world. We explored this issue in a large, multiethnic cohort from the developing nation of Mauritius. RESEARCH DESIGN AND METHODS Population-based surveys were undertaken in 1987, 1992, and 1998. The 9,559 participants (20–82 years old) comprised 66% South Asian (Indian), 27% Creole (African), and 7% Chinese descent. Mortality was ascertained in 2007. RESULTS Over a median 15.1-year follow-up, 1,557 participants died. Compared with those with normal glucose tolerance, the all-cause mortality hazard ratios (HR) for known diabetes, newly diagnosed diabetes, and impaired glucose tolerance were 3.35 (95% CI 2.77–4.04), 2.11 (1.73–2.57), and 1.53 (1.26–1.87) in South Asians and 2.14 (1.65–2.79), 1.41 (1.06–1.88), and 1.08 (0.83–1.40) in Africans, respectively. Those with impaired fasting glucose were not at increased risk in either ethnicity. In the Chinese, only those with known diabetes were at increased risk of mortality with HR 3.68 (1.87–7.25). CONCLUSIONS This is the first study in a developing country of the impact of glucose intolerance on mortality in an African population, and one of the first studies of a South Asian population. It shows that the impact on mortality in these populations in Mauritius is comparable to that seen in developed countries. These results are important in a global context for future health policy in light of the impact of the rapid increase in prevalence of diabetes, especially in developing nations.