Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis
Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis
复制标题
DOI：
10.1016/s2213-8587(14)70248-7
复制
发表时间：
2015-03-01
影响因子：
44.5
通讯作者：
Woodward, Mark
中科院分区：
文献类型：
--
作者：
Huxley, Rachel R.;Peters, Sanne A. E.;Woodward, Mark
背景研究表明与1型糖尿病相关的死亡率存在性别差异。我们进行了一项荟萃分析，以提供关于1型糖尿病对全原因死亡风险和特定原因结果影响的任何性别差异的可靠估计。方法我们系统地搜索PubMed，检索在1966年1月1日至2014年11月26日发表的研究。选定的研究报告了与1型糖尿病相关的标准化死亡率比(SMR)或风险比的性别估计，无论是针对所有原因的死亡还是针对特定原因的结果。我们使用逆方差加权的随机效应Meta分析，获得了全因死亡率、心血管疾病、肾脏疾病、癌症、意外和自杀的综合结果以及与1型糖尿病相关的冠心病和中风事件的性别特定SMR及其合并比率(女性与男性)。研究数据来自26项研究，包括214 114个个体和15 273个事件。全因死亡率的SMR男女比例为1.37(95%可信区间1.21-1.56)，卒中发病率为1.37(1.03-1.81)，致命性肾病为1.44(1.02-2.05)，致命性心血管疾病为1.86(1.62-2.15)。对于冠心病事件，性别差异更为极端；SMR的男女合并比为2.54(95%CI为1.80-3.60)。没有证据表明，与癌症、事故和自杀相关的1型糖尿病的死亡率存在性别差异。与1型糖尿病男性相比，1型糖尿病女性全因死亡的额外风险大约高出40%，致命和非致命血管事件的额外风险高出一倍。
Background Studies have suggested sex differences in the mortality rate associated with type 1 diabetes. We did a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes.Methods We systematically searched PubMed for studies published between Jan 1, 1966, and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. We used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes.Findings Data from 26 studies including 214 114 individuals and 15 273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1.37 (95% CI 1.21-1.56), for incident stroke 1.37 (1.03-1.81), for fatal renal disease 1.44 (1.02-2.05), and for fatal cardiovascular diseases 1.86 (1.62-2.15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2.54 (95% CI 1.80-3.60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide.Interpretation Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes.