Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.
Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.
复制标题
DOI：
10.1001/jama.2016.19720
复制
发表时间：
2017-01-17
期刊：
影响因子：
--
通讯作者：
China Kadoorie Biobank Collaborative Group
中科院分区：
文献类型：
--
作者：
Bragg F;Holmes MV;Iona A;Guo Y;Du H;Chen Y;Bian Z;Yang L;Herrington W;Bennett D;Turnbull I;Liu Y;Feng S;Chen J;Clarke R;Collins R;Peto R;Li L;Chen Z;China Kadoorie Biobank Collaborative Group
近几十年来，中国的糖尿病患病率大幅上升，但目前尚无与糖尿病相关的高死亡率的可靠估计。评估与糖尿病相关的比例超额死亡率，并估计中国农村和城市与糖尿病相关的绝对超额死亡率。2004年6月至2008年7月，一项为期7年的全国性前瞻性研究招募了来自中国10个地区（5个农村，5个城市）的512869名年龄在30-79岁之间的成年人，随访至2014年1月。基线时记录的糖尿病（既往诊断或筛查）。全因死亡率和特定原因死亡率，通过已建立的死亡登记处收集。采用Cox回归估计基线时糖尿病患者与非糖尿病患者的校正死亡率比（rr）。总体而言，平均（SD）年龄为51.5（10.7）岁，59% （n=302,618）为女性，5.9% （n=30,280）患有糖尿病（农村4.1%，城市8.1%，男性5.8%，女性6.1%，先前诊断3.1%，筛查检测2.8%）。在364万人年的随访中，有24909人死亡，其中3384人患有糖尿病。与没有糖尿病的成年人相比，糖尿病患者的全因死亡风险显著增加（每10万人中有1373人死亡，646人死亡；调整后的相对危险度为2.00 [95%CI， 1.93至2.08]），农村地区的风险高于城市地区（农村地区的相对危险度为2.17 [95%CI， 2.07至2.29]；城市地区的相对危险度为1.83 [95%CI， 1.73至1.94]）。糖尿病的存在与缺血性心脏病（3287例死亡，RR, 2.40 [95%CI， 2.19至2.63]）、中风（4444例死亡，RR, 1.98 [95%CI， 1.81至2.17]）、慢性肝病（481例死亡，RR, 2.32 [95%CI， 1.76至3.06]）、感染（425例死亡，RR, 2.29 [95%CI， 1.76至2.99]）、肝癌（1325例死亡，RR, 1.54 [95%CI， 1.28至1.86]）、胰腺（357例死亡，RR, 1.84 [95%CI， 1.35至2.51]）、女性乳腺癌(217例死亡；RR, 1.84 [95%CI, 1.24 ~ 2.74])和女性生殖系统（210例死亡；RR, 1.81 [95%CI, 1.20 ~ 2.74]）。对于慢性肾脏疾病（365例死亡），农村地区的RR高于城市地区（18.69 [95%CI， 14.22至24.57]对6.83 [95%CI， 4.73至9.88]）。在糖尿病患者中，10%的死亡（农村16%，城市4%）是由于明确或可能的糖尿病酮症酸中毒或昏迷（408例死亡）。在中国的成年人中，糖尿病与一系列心血管和非心血管疾病的死亡率增加有关。尽管糖尿病在城市地区更为常见，但在农村地区，它与更高的超额死亡率有关。
In China diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. To assess the proportional excess mortality associated with diabetes, and to estimate the diabetes-related absolute excess mortality in rural and urban China. A 7-year nationwide prospective study of 512,869 adults aged 30-79 years from 10 (5 rural, 5 urban) localities across China, recruited from 6/2004 to 7/2008 and followed until 1/2014. Diabetes (previously diagnosed or screen-detected) recorded at baseline. All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratios (RRs) comparing those with versus without diabetes at baseline. Overall, the mean (SD) age was 51.5 (10.7) years, 59% (n=302,618) were women, and 5.9% (n=30,280) had diabetes (rural 4.1%, urban 8.1%, men 5.8%, women 6.1%, previously diagnosed 3.1%, screen-detected 2.8%). During 3.64 million person-years of follow-up, there were 24,909 deaths, including 3,384 among individuals with diabetes. Compared to adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100,000; adjusted RR, 2.00 [95%CI, 1.93 to 2.08]), which was higher in rural than urban areas (rural RR, 2.17 [95%CI 2.07 to 2.29]; urban RR, 1.83 [95%CI, 1.73 to 1.94]). Presence of diabetes was associated with increased mortality from ischaemic heart disease (3287 deaths; RR, 2.40 [95%CI, 2.19 to 2.63]), stroke (4444 deaths; RR, 1.98 [95%CI, 1.81 to 2.17]), chronic liver disease (481 deaths; RR, 2.32 [95%CI, 1.76 to 3.06]), infections (425 deaths; RR, 2.29 [95%CI, 1.76 to 2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95%CI 1.28 to1.86]), pancreas (357 deaths; RR, 1.84 [95%CI, 1.35 to 2.51]), female breast (217 deaths; RR, 1.84 [95%CI, 1.24 to 2.74]), and female reproductive system (210 deaths; RR, 1.81 [95%CI, 1.20 to 2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural than urban areas (18.69 [95%CI, 14.22 to 24.57] versus 6.83 [95%CI, 4.73 to 9.88]). Among those with diabetes, 10% of all deaths (rural 16%, urban 4%) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and non-cardiovascular diseases. Although diabetes was more common in urban areas, it was associated with a greater excess mortality in rural areas.
登录
查看更多内容
影响因子：
16.2
作者：
An Y;Zhang P;Wang J;Gong Q;Gregg EW;Yang W;Li H;Zhang B;Shuai Y;Chen Y;Engelgau MM;Cheng Y;Hu Y;Bennett PH;Li G
通讯作者：
Li G
DOI：
10.1016/s0140-6736(15)00340-2
发表时间：
2015-10-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
Chen Z;Peto R;Zhou M;Iona A;Smith M;Yang L;Guo Y;Chen Y;Bian Z;Lancaster G;Sherliker P;Pang S;Wang H;Su H;Wu M;Wu X;Chen J;Collins R;Li L;China Kadoorie Biobank (CKB) collaborative group
通讯作者：
China Kadoorie Biobank (CKB) collaborative group
影响因子：
5.1
作者：
Shen, Chen;Schooling, C. Mary;Lam, Tai Hing
通讯作者：
Lam, Tai Hing
影响因子：
158.5
作者：
Yang, Wenying;Lu, Juming;He, Jiang
通讯作者：
He, Jiang
影响因子：
8.2
作者：
Peters, Sanne A. E.;Huxley, Rachel R.;Woodward, Mark
通讯作者：
Woodward, Mark