Background: Prior studies regarding the effect of racial status on post-myocardial infarction(MI)in subjects with diabetes have yielded conflicting results. We evaluated the effect of diabetes status on racial differences in post-MI mortality and morbidity for a 7-year period, from 1990 through 1997. Methods: All patients discharged with the primary diagnosis of acute MI from any Veterans Affairs Medical Center in the country between October 1990 and September 1997 were identified. Demographic, comorbid conditions,inpatient, outpatient, mortality, a nd readmission data were extracted. Mortality, revascularization, readmissions, and length of hospital stay for MI were compared for the group with diabetes and that without diabetes. Comparison was made between black and white patients. In dependent predictors of survival using a Cox regression model were examined. Res ults: We identified 67 889 patients with MI of whom 17 756(26%)had diabetes. Ra ce status was known for 66 506 subjects of whom 55 731(84%)were white and 8437( 13%)were black. Regardless of the race, the diabetic patients tended to have hi gher mortality than nondiabetic patients. The post-MI mortality during the enti re follow-up period tended to be similar between blacks and whites for the nond iabetic patients, whereas the mortality tended to be lower in blacks than in whi tes in diabetic patients. Conclusions: Mortality from post-MI is significantly lower in blacks with diabetes than in whites with diabetes. In contrast, no raci al difference in long-term mortality was seen among subjects without diabetes. Thus, it appears that diabetes status determines racial variation in post-MI mo rtality. The reasons for better survival post-MI of blacks in general and among subjects with diabetes in particular need to be further investigated. Background: Prior studies regarding the effect of racial status on post-myocardial infarction (MI) in subjects with diabetes have yielded conflicting results. We evaluated the effect of diabetes status on racial differences in post-MI mortality and morbidity for a 7-year period , from 1990 through 1997. Methods: All patients discharged with the primary diagnosis of acute MI from any Veterans Affairs Medical Center in the country between October 1990 and September 1997 identified. Demographic, comorbid conditions, inpatient, outpatient, mortality, a nd readmission data were extracted. Mortality, revascularization, readmissions, and length of hospital stay for MI were compared for the group with diabetes and that without diabetes. Comparison was made between black and white patients. In dependent predictors of survival using a Cox regression model . Res ults: We identified 67 889 patients with MI of whom 17 756 (26%) had diabetes. Ra ce status was known for 66 506 subjects of Regardless of the race, the diabetic patients tended to have hi gher mortality than nondiabetic patients. The post-MI mortality during the enti re follow-up period tended (84%) were white and 8437 (13%) were black. to be similar between blacks and whites for the nond iabetic patients, and the mortality tended to be lower in blacks than in whi tes in diabetic patients. Conclusions: Mortality from post-MI is significantly lower in blacks with diabetes than in whites with diabetes. In contrast, no raci al difference in long-term mortality was seen among subjects without diabetes. Thus, it appears that diabetes status determines racial variation in post-MI mo rtality. The reasons for better survival post-MI of blacks in general and among subjects with diabetes in particular need to be further investigated.