Quantification of diabetes comorbidity risks across life using nation-wide big claims data.
Quantification of diabetes comorbidity risks across life using nation-wide big claims data.
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DOI：
10.1371/journal.pcbi.1004125
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发表时间：
2015-04
影响因子：
4.3
通讯作者：
Thurner S
中科院分区：
文献类型：
--
作者：
Klimek P;Kautzky-Willer A;Chmiel A;Schiller-Frühwirth I;Thurner S
尽管糖尿病的研究取得了实质性进展，但有关其共病和临床异质性的重要问题仍然存在。为了探索这些问题，我们开发了一个框架，首次允许量化全国范围内的风险及其年龄和性别对每个糖尿病共病的依赖，以及这种关联可能是后果性的还是因果的，在近200万名患者的样本中。这项研究相当于近40,000项临床测量。我们确认了糖尿病患者患帕金森氏病风险增加这一极具争议的关系，使用的队列比以前关于这一关系的研究大10倍。1型糖尿病的检测导致抑郁症的检测，而2型糖尿病和精神分裂症之间存在强烈的共病关系，这表明类似的致病或药物相关机制。例如，我们发现糖尿病患者在睡眠障碍和充血性心力衰竭的进展方面存在显著的性别差异。高血压是一种对性别高度敏感的共病，女性在育龄期间风险较低，但在其他年龄阶段风险较高。这些结果可能有助于改进普通人群的筛查做法。糖尿病的临床治疗必须解决多种并存疾病的年龄和性别依赖问题。我们首次在包含近200万患者的全国范围内的索赔数据集中量化了1型和2型糖尿病每种可能的共病的年龄和性别相关的相对风险，并测试这种关联可能是后果性的还是因果的。因此，这项研究包含了近40,000项单一的临床测量，所有这些测量都是整个国家可用的最大患者数量。我们确认了糖尿病与帕金森病的关系，并发现了1型和2型糖尿病患者精神障碍的不同进展途径。在许多其他结果中，我们还报告了充血性心力衰竭、睡眠障碍、高血压和高脂血症进展的显著性别差异。这项工作首次对所有糖尿病合并症及其对患者年龄和性别的依赖性进行了完整的统计描述。这些结果可能会立即用于改善糖尿病患者的筛查实践和治疗，因为更准确地诊断和治疗重要的合并症。
Despite substantial progress in the study of diabetes, important questions remain about its comorbidities and clinical heterogeneity. To explore these issues, we develop a framework allowing for the first time to quantify nation-wide risks and their age- and sex-dependence for each diabetic comorbidity, and whether the association may be consequential or causal, in a sample of almost two million patients. This study is equivalent to nearly 40,000 single clinical measurements. We confirm the highly controversial relation of increased risk for Parkinson’s disease in diabetics, using a 10 times larger cohort than previous studies on this relation. Detection of type 1 diabetes leads detection of depressions, whereas there is a strong comorbidity relation between type 2 diabetes and schizophrenia, suggesting similar pathogenic or medication-related mechanisms. We find significant sex differences in the progression of, for instance, sleep disorders and congestive heart failure in diabetic patients. Hypertension is a highly sex-sensitive comorbidity with females being at lower risk during fertile age, but at higher risk otherwise. These results may be useful to improve screening practices in the general population. Clinical management of diabetes must address age- and sex-dependence of multiple comorbid conditions. We quantify for the first time age- and gender-dependent relative risks for each possible comorbidity of type 1 and 2 diabetes in a nation-wide claims dataset containing almost two million patients, and test whether the association may be consequential or causal. This study therefore contains almost 40,000 single clinical measurements, all with the maximum patient number available in an entire country. We confirm the relation between diabetes and Parkinson's disease, and find different progression routes of mental disorders in type 1 and type 2 diabetics. Among many other results, we also report significant gender differences in the progression of congestive heart failure, sleep disorders, hypertension, and hyperlipidemia. This work provides the first complete statistical description of all diabetic comorbidities and their dependence on patient age and sex. These results may be of immediate use to improve screening practices and therapy of diabetic patients due to more accurate diagnosis and treatment of important comorbidities.
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影响因子：
--
作者：
Almdal, T;Scharling, H;Vestergaard, H
通讯作者：
Vestergaard, H
影响因子：
7.6
作者：
Ajilore, Olusola;Haroon, Ebrahim;Kumar, Anand
通讯作者：
Kumar, Anand
影响因子：
4.7
作者：
Engum, Anne
通讯作者：
Engum, Anne
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
DOI：
10.1111/j.1532-5415.2005.53565.x
发表时间：
2005-11-01
影响因子：
6.3
作者：
Lifford, KL;Curhan, GC;Grodstein, F
通讯作者：
Grodstein, F