Favourable changes in mortality in people with diabetes: US NHANES 1999-2010.

Favourable changes in mortality in people with diabetes: US NHANES 1999-2010.
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DOI:
10.1111/dom.13039
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发表时间:
2018-01
期刊:
Diabetes, obesity & metabolism
影响因子:
--
通讯作者:
Sugiyama T
Sugiyama T
中科院分区:
其他
文献类型:
--
作者:
Tsujimoto T;Kajio H;Sugiyama T

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糖尿病相关并发症在过去二十年中有所下降。我们的目的是研究在1999年至2010年的国家健康和营养检查调查(NHANES)中,糖尿病患者的死亡率是否随时间推移而改善。我们使用NHANES 1999年至2004年和2005年至2010年的数据进行了前瞻性队列研究。对于主要分析,我们使用考克斯比例风险模型比较了糖尿病受试者与非糖尿病受试者的死亡率结局(总死亡、心血管死亡、心脏病死亡和癌症死亡)的未校正、年龄校正和多变量校正的风险比(HR)。对于每个死亡率结局,HR 2005年至2010年期间糖尿病参与者中的95%置信区间低于1999年至2004年期间(全因死亡,2.76 [1.87 - 4.08] vs 4.23 [2.57 - 6.98];心血管死亡,2.70 [1.20 - 6.04] vs 8.82 [3.28 - 23.70];心源性死亡,2.45 [0.98 - 6.09] vs 15.55 [7.01 - 34.50];癌症死亡,2.33 [0.87 - 6.23] vs 3.03 [1.20 - 7.65])。与1999年至2004年期间的死亡率结果相比,2005年至2010年期间心血管疾病死亡率(-54.0%)和心脏病死亡率(-64.8%)下降幅度更大。在年龄校正和多变量校正模型中,2005-2010年期间,糖尿病和非糖尿病受试者之间的总死亡、心血管死亡和心源性死亡的累积事件率无显著差异; 1999-2004年期间的情况并非如此。2005-2010年期间,恶性肿瘤是主要死亡原因。与1999年至2004年NHANES相比,2005年至2010年NHANES期间糖尿病患者的总死亡、心血管死亡和心源性死亡结局显著改善。
Diabetes‐related complications have declined during the past two decades. We aimed to examine whether mortality in people with diabetes improved over time in the 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). We conducted a prospective cohort study using 1999 to 2004 and 2005 to 2010 data from the NHANES. For primary analyses, we compared the unadjusted, age‐adjusted and multivariable‐adjusted hazard ratios (HR) for mortality outcomes (total, cardiovascular, cardiac and cancer deaths) of the participants with diabetes with those without diabetes using Cox proportional hazard models. For each mortality outcome, HR (95% confidence interval) in diabetic participants during the period 2005 to 2010 was lower than that during the period 1999 to 2004 (all‐cause death, 2.76 [1.87‐4.08] vs 4.23 [2.57‐6.98]; cardiovascular death, 2.70 [1.20‐6.04] vs 8.82 [3.28‐23.70]; cardiac death, 2.45 [0.98‐6.09] vs 15.55 [7.01‐34.50]; cancer death, 2.33 [0.87‐6.23] vs 3.03 [1.20‐7.65]). Compared with mortality outcome during the period 1999 to 2004, greater declines in mortality during the period 2005 to 2010 were observed for cardiovascular (−54.0%) and cardiac deaths (−64.8%). In age‐adjusted and multivariable‐adjusted models, the cumulative event rates for total, cardiovascular and cardiac deaths were not significantly different between participants with and without diabetes during the period 2005–2010; this was not the case during the period 1999–2004. The leading cause of death was malignant neoplasm during the period 2005–2010. Considerably improved outcomes for total, cardiovascular and cardiac deaths were observed in people with diabetes during the 2005 to 2010 NHANES compared to the 1999 to 2004 NHANES.
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