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Diabetes Care. 2016 Nov;39(11):1987-1995. Epub 2016 Aug 4.

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis.

Author information

1
REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.
2
Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
3
Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.
4
Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.
5
Univeristy of Girona, Girona, Spain.
6
San Jose Norte Health Centre, Zaragoza, Spain.
7
Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.
8
Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain.
9
Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain.
10
Murcian Health Departament, Murcia, Spain.
11
University of Murcia, Murcia, Spain.
12
Murcian Institute of Biomedical Research, Murcia, Spain.
13
Navarre Public Health Institute, Pamplona, Spain.
14
Research Network for Health Services in Chronic Disease, Pamplona, Spain.
15
Navarra Health Research Institute, Pamplona, Spain.
16
Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain.
17
Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain.
18
Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain.
19
Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.
20
Primary Care Division, Department of Family Medicine, Primary Care Center San Pablo, Sevilla, Spain.
21
Carlos III Health Institute, Madrid, Spain.
22
Health and Consumers Department, Murcia Government, Murcia, Spain.
23
Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain.
24
Diabetes Strategy, Andalusia Health Service, Seville, Spain.
25
Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
26
Consortium for Biomedical Research in Diabetes and Associated Metabolic Diseases, Madrid, Spain.
27
Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
28
Public Health Agency, Government of Catalonia, Barcelona, Spain.
29
Department of Urology, Hospital del Mar, Barcelona, Spain.
30
REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain mgrau@imim.es.
31
University of Barcelona, Barcelona, Spain.

Abstract

OBJECTIVE:

Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death.

RESEARCH DESIGN AND METHODS:

We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths.

RESULTS:

We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes.

CONCLUSIONS:

Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.

PMID:
27493134
DOI:
10.2337/dc16-0614
[Indexed for MEDLINE]

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