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BMC Public Health. 2018 Dec 3;18(1):1331. doi: 10.1186/s12889-018-6265-0.

Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies.

Ptushkina V1,2, Jacobs E3,4, Schipf S5,4, Völzke H5,6,4, Markus MRP6,7,4, Nauck M6,8, Meisinger C9, Peters A9,4, Maier W10,4, Herder C11,4,12, Roden M13,11,4, Rathmann W3,4,12.

Author information

1
Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany. violetta.ptushkina@ddz.de.
2
German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany. violetta.ptushkina@ddz.de.
3
Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
4
German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
5
Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
6
German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.
7
Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
8
Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
9
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
10
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
11
Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
12
Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
13
Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Abstract

BACKGROUND:

Previous studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations.

METHODS:

Data of persons aged 30-79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008-2012, n = 2539) and KORA-F4 (South Germany, 2006-2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population.

RESULTS:

The prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11-2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33-2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01-1.78).

CONCLUSIONS:

This study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.

KEYWORDS:

Macrovascular disease; Population-based studies; Prevalence; Regional differences; Type 2 diabetes

PMID:
30509230
PMCID:
PMC6276210
DOI:
10.1186/s12889-018-6265-0
[Indexed for MEDLINE]
Free PMC Article

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