Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up.
Avoidable deaths
Cohort studies
Coronary heart disease
Diabetes
Mortality
Journal
Journal of epidemiology and community health
ISSN: 1470-2738
Titre abrégé: J Epidemiol Community Health
Pays: England
ID NLM: 7909766
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
24
04
2020
revised:
17
06
2020
accepted:
20
06
2020
pubmed:
6
7
2020
medline:
3
9
2021
entrez:
5
7
2020
Statut:
ppublish
Résumé
Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emergence of other diabetes-related complications and ultimately to diversification of the causes of death. The study population of this observational historic cohort study consisted of subjects with DM, who had purchased for at least one insulin prescription and/or one oral antidiabetic between January 1, 1997 and December 31, 2010 (N=199 354), and a reference population matched by age, sex and hospital district (N=199 354). Follow-up was continued until December 31, 2017. All-cause and cause-specific mortality (cancer, CHD and stroke) was analysed with Poisson and Cox's regression. Associations between baseline medications and mortality were analysed using LASSO (Least Absolute Shrinkage and Selection Operator) models. The mortality rates were significantly elevated among the patients with DM. However, the relative risk of all-cause mortality between the DM and reference populations tended to converge during the follow-up. The lowering trend was most apparent in CHD mortality. The difference between DM and reference populations in stroke mortality vanished with a later entrance to the follow-up period. There were a few differences between DM and no-DM groups with respect to how baseline medications were associated with mortality. The gap between the mortality of patients with diabetes compared to subjects who are non-diabetic diminished markedly during the 21-year period. This was driven primarily by the reduced CHD mortality.
Sections du résumé
BACKGROUND
Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emergence of other diabetes-related complications and ultimately to diversification of the causes of death.
METHODS
The study population of this observational historic cohort study consisted of subjects with DM, who had purchased for at least one insulin prescription and/or one oral antidiabetic between January 1, 1997 and December 31, 2010 (N=199 354), and a reference population matched by age, sex and hospital district (N=199 354). Follow-up was continued until December 31, 2017. All-cause and cause-specific mortality (cancer, CHD and stroke) was analysed with Poisson and Cox's regression. Associations between baseline medications and mortality were analysed using LASSO (Least Absolute Shrinkage and Selection Operator) models.
RESULTS
The mortality rates were significantly elevated among the patients with DM. However, the relative risk of all-cause mortality between the DM and reference populations tended to converge during the follow-up. The lowering trend was most apparent in CHD mortality. The difference between DM and reference populations in stroke mortality vanished with a later entrance to the follow-up period. There were a few differences between DM and no-DM groups with respect to how baseline medications were associated with mortality.
CONCLUSIONS
The gap between the mortality of patients with diabetes compared to subjects who are non-diabetic diminished markedly during the 21-year period. This was driven primarily by the reduced CHD mortality.
Identifiants
pubmed: 32620580
pii: jech-2019-213602
doi: 10.1136/jech-2019-213602
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
950-956Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.