Associations of Age at Diagnosis and Duration of Diabetes With Morbidity and Mortality Among Older Adults.
Associations of Age at Diagnosis and Duration of Diabetes With Morbidity and Mortality Among Older Adults.
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DOI：
10.1001/jamanetworkopen.2022.32766
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发表时间：
2022-09-01
影响因子：
13.8
通讯作者：
Zhong, Judy
中科院分区：
文献类型：
--
作者：
Cigolle, Christine T.;Blaum, Caroline S.;Lyu, Chen;Ha, Jinkyung;Kabeto, Mohammed;Zhong, Judy
在50岁及以上的成年人中，糖尿病确诊年龄与远期预后风险是否相关？这项对36060名50岁及以上成年人进行的队列研究使用了来自全国纵向健康调查的数据，发现在50岁至59岁时被诊断为糖尿病的人与心脏病、中风、残疾、认知障碍和死亡的风险增加显著相关。然而，糖尿病和所有预后之间的相关性随着糖尿病诊断年龄的增加而降低，即使考虑到糖尿病病程。糖尿病与负面健康结果之间的关联差异支持不同诊断年龄组的糖尿病管理。这项队列研究评估了在50岁及以上的美国成年人中，糖尿病确诊年龄与心脏病、中风、残疾、认知障碍和全因死亡率的关系。老年人在诊断2型糖尿病时的年龄和病程上差异很大，但治疗往往忽略了这种异质性。在50岁及以上人群中，研究糖尿病与非糖尿病、确诊年龄和糖尿病病程与负面健康结局的关系。这项队列研究包括1995年至2018年健康与退休研究(HRS)浪潮的参与者，HRS是一项基于人群的两年一度的纵向健康访谈调查，针对美国老年人。研究样本包括50岁或50岁以上的成年人(n = 36 060)，入选时没有糖尿病。对2021年6月1日至2022年7月31日的数据进行了分析。糖尿病的存在，特别是糖尿病诊断的年龄，是这项研究的主要风险。诊断时的年龄被定义为受访者首次报告糖尿病的年龄。患有糖尿病的成年人被分成3个诊断年龄组：50-59岁，60-69岁，70岁以上。对于每个糖尿病确诊年龄组，构建了从未患糖尿病的受访者的倾向分数匹配的对照组。评估了糖尿病与关键结局发生率的相关性，包括心脏病、中风、残疾、认知障碍和全因死亡率，并比较了确诊年龄组和匹配对照组中糖尿病与非糖尿病的相关性。共有7739名HRS受访者发展为糖尿病，并被纳入分析(4267名女性[55.1%]；确诊时的平均[SD]年龄为67.4[9.9]岁)。确诊年龄组包括1,866名50至59岁的受访者，2,834名60至69岁的受访者，3,039名70岁或以上的受访者；28名 321名HRS受访者从未患过糖尿病。确诊年龄为50-59岁的患者与心脏病(危险比，1.66[95%CI，1.40-1.96])、中风(HR，1.64[95%CI，1.30-2.07])、残疾(HR，2.08[95%CI，1.59-2.72])、认知障碍(HR，1.30[95%CI，1.05-1.61])和死亡率(HR，1.49[95%CI，1.59-2.72])和死亡率(HR，1.49[95%CI，1.59-2.72])显著相关。1.29-1.71])与对照组相比，即使考虑了糖尿病病程。随着确诊年龄的增加，这些相关性显著降低。被诊断为70岁或70岁以上的糖尿病患者只显示出与死亡率升高的结果显著相关(HR，1.08[95%CI，1.01-1.17])。这项队列研究的结果表明，糖尿病确诊时的年龄与预后存在差异，年龄较小的人群患心脏病、中风、残疾、认知障碍和各种原因死亡的风险更高。这些发现加强了糖尿病的临床异质性，并强调了改善早期诊断的成人糖尿病管理的重要性。
Is age at diabetes diagnosis associated with the risk of distal outcomes among adults 50 years and older? This cohort study of 36 060 adults 50 years and older used data from a national longitudinal health survey and found that diabetes diagnosed at 50 to 59 years of age was significantly associated with elevated risks of incident heart disease, stroke, disability, cognitive impairment, and mortality. However, the associations between diabetes and all outcomes decreased as age at diabetes diagnosis increased, even when accounting for diabetes duration. Differences in the association of diabetes with negative health outcomes support differential diabetes management across age-at-diagnosis groups. This cohort study assesses the association of age at diabetes diagnosis with heart disease, stroke, disability, cognitive impairment, and all-cause mortality among US adults aged 50 years and older. Older adults vary widely in age at diagnosis and duration of type 2 diabetes, but treatment often ignores this heterogeneity. To investigate the associations of diabetes vs no diabetes, age at diagnosis, and diabetes duration with negative health outcomes in people 50 years and older. This cohort study included participants in the 1995 through 2018 waves of the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the US. The study sample included adults 50 years or older (n = 36 060) without diabetes at entry. Data were analyzed from June 1, 2021, to July 31, 2022. The presence of diabetes, specifically the age at diabetes diagnosis, was the main exposure of the study. Age at diagnosis was defined as the age when the respondent first reported diabetes. Adults who developed diabetes were classified into 3 age-at-diagnosis groups: 50 to 59 years, 60 to 69 years, and 70 years and older. For each diabetes age-at-diagnosis group, a propensity score–matched control group of respondents who never developed diabetes was constructed. The association of diabetes with the incidence of key outcomes—including heart disease, stroke, disability, cognitive impairment, and all-cause mortality—was estimated and the association of diabetes vs no diabetes among the age-at-diagnosis case and matched control groups was compared. A total of 7739 HRS respondents developed diabetes and were included in the analysis (4267 women [55.1%]; mean [SD] age at diagnosis, 67.4 [9.9] years). The age-at-diagnosis groups included 1866 respondents at 50 to 59 years, 2834 at 60 to 69 years, and 3039 at 70 years or older; 28 321 HRS respondents never developed diabetes. Age at diagnosis of 50 to 59 years was significantly associated with incident heart disease (hazard ratio [HR], 1.66 [95% CI, 1.40-1.96]), stroke (HR, 1.64 [95% CI, 1.30-2.07]), disability (HR, 2.08 [95% CI, 1.59-2.72]), cognitive impairment (HR, 1.30 [95% CI, 1.05-1.61]), and mortality (HR, 1.49 [95% CI, 1.29-1.71]) compared with matched controls, even when accounting for diabetes duration. These associations significantly decreased with advancing age at diagnosis. Respondents with diabetes diagnosed at 70 years or older only showed a significant association with the outcome of elevated mortality (HR, 1.08 [95% CI, 1.01-1.17]). The findings of this cohort study suggest that age at diabetes diagnosis was differentially associated with outcomes and that younger age groups were at elevated risk of heart disease, stroke, disability, cognitive impairment, and all-cause mortality. These findings reinforce the clinical heterogeneity of diabetes and highlight the importance of improving diabetes management in adults with earlier diagnosis.
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