Association Between Socioeconomic Status and Mortality, Cardiovascular Disease, and Cancer in Patients With Type 2 Diabetes
Association Between Socioeconomic Status and Mortality, Cardiovascular Disease, and Cancer in Patients With Type 2 Diabetes
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DOI：
10.1001/jamainternmed.2016.2940
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发表时间：
2016-08-01
影响因子：
39
通讯作者：
Gudbjornsdottir, Soffia
中科院分区：
文献类型：
--
作者：
Rawshani, Araz;Svensson, Ann-Marie;Gudbjornsdottir, Soffia
重要性社会经济地位和生存率之间的关联基于全因，心血管（CV），糖尿病相关，2型糖尿病和癌症死亡率尚未在一个设置的人公平获得医疗保健与调整的重要confounders.OBJECTIVE确定是否收入，教育水平，婚姻状况和出生国的人是独立相关的全因，CV，设计、设置和参与者进行了一项研究，该研究包括瑞典国家糖尿病登记处（2003年1月1日至2010年12月31日）中所有217364名年龄小于70岁的2型糖尿病患者，他们被监测至2012年12月31日。一个考克斯比例风险回归模型与多达17个covariates被用于analysis.Main结果和措施全因，CV，糖尿病相关的，和癌症mortarity.Results的217 364人包括在研究中，平均（SD）年龄为58.3（9.3）岁，130 839人（60.2%）是男性。共有19105例全因死亡，分别有11423例（59.8%）、6984例（36.6%）和6438例（33.7%）CV、糖尿病相关或癌症死亡。与单身者相比，使用完全校正模型确定的已婚者全因、CV和糖尿病相关死亡率的风险比（HR）分别为0.73（95%CI，0.70-0.77）、0.67（95%CI，0.63-0.71）和0.62（95%CI，0.57-0.67）。婚姻状况与总体癌症死亡率无关，但已婚男性患前列腺癌的死亡风险比单身男性低33%，HR为0.67（95%CI，0.50-0.90）。最低收入与最高收入五分位数的全因、CV、糖尿病相关和癌症死亡率的HR比较分别为1.71（95% CI，1.60-1.83）、1.87（95% CI，1.72-2.05）、1.80（95% CI，1.61-2.01）和1.28（95% CI，1.14-1.44）。与本地瑞典人相比，非西方移民的全因、CV、糖尿病相关和癌症死亡率的HR为0.55（95% CI，0.48-0.63）、0.46（95% CI，0.38-0.56）、0.38（95% CI，0.29-0.49）和0.72（95% CI，0.58-0.88），这些HR几乎不受协变量调整的影响。大专/大学学历与9年或更少教育的风险比为0.85（95% CI，0.80-0.90），0.84（95% CI，0.78-0.91）和0.84（95%CI，0.76-0.93）分别为全因、CV和癌症死亡率。社会经济地位是全因死亡率和心血管死亡率的有力预测因素，但不如癌症死亡的预测因素强。
IMPORTANCE The association between socioeconomic status and survival based on all-cause, cardiovascular (CV), diabetes-related, and cancer mortality in type 2 diabetes has not been examined in a setting of persons with equitable access to health care with adjustment for important confounders.OBJECTIVE To determine whether income, educational level, marital status, and country of birth are independently associated with all-cause, CV, diabetes-related, and cancer mortality in persons with type 2 diabetes.DESIGN, SETTING, AND PARTICIPANTS A study including all 217 364 individuals younger than 70 years with type 2 diabetes in the Sweden National Diabetes Register (January 1, 2003, to December 31, 2010) who were monitored through December 31, 2012, was conducted. A Cox proportional hazards regression model with up to 17 covariates was used for analysis.MAIN OUTCOMES AND MEASURES All-cause, CV, diabetes-related, and cancer mortality.RESULTS Of the 217 364 persons included in the study, mean (SD) age was 58.3 (9.3) years and 130 839 of the population (60.2%) was male. There were a total of 19 105 all-cause deaths with 11 423 (59.8%), 6984 (36.6%), and 6438 (33.7%) CV, diabetes-related, or cancer deaths, respectively. Compared with being single, hazard ratios (HRs) for married individuals, determined using fully adjusted models, for all-cause, CV, and diabetes-related mortality were 0.73 (95% CI, 0.70-0.77), 0.67 (95% CI, 0.63-0.71), and 0.62 (95% CI, 0.57-0.67), respectively. Marital status was not associated with overall cancer mortality, but married men had a 33% lower risk of prostate cancer mortality compared with single men, with an HR of 0.67 (95% CI, 0.50-0.90). Comparison of HRs for the lowest vs highest income quintiles for all-cause, CV, diabetes-related, and cancer mortality were 1.71 (95% CI, 1.60-1.83), 1.87 (95% CI, 1.72-2.05), 1.80 (95% CI, 1.61-2.01), and 1.28 (95% CI, 1.14-1.44), respectively. Compared with native Swedes, HRs for all-cause, CV, diabetes-related, and cancer mortality for non-Western immigrants were 0.55 (95% CI, 0.48-0.63), 0.46 (95% CI, 0.38-0.56), 0.38 (95% CI, 0.29-0.49), and 0.72 (95% CI, 0.58-0.88), respectively, and these HRs were virtually unaffected by covariate adjustment. Hazard ratios for those with a college/university degree compared with 9 years or less of education were 0.85 (95% CI, 0.80-0.90), 0.84 (95% CI, 0.78-0.91), and 0.84 (95% CI, 0.76-0.93) for all-cause, CV, and cancer mortality, respectively.CONCLUSIONS AND RELEVANCE Independent of risk factors, access to health care, and use of health care, socioeconomic status is a powerful predictor of all-cause and CV mortality but was not as strong as a predictor of death from cancer.