Alcohol Consumption and Complications of Diabetes

描述(由申请人提供)：这项提案将评估在北加利福尼亚州凯撒永久保健环境中接受医疗护理的65,996名糖尿病患者中，由于饮酒而导致的糖尿病并发症发生率和医疗成本的差异。我们建议在长达11年的随访中，确定糖尿病并发症的发生率和全因死亡率，这些并发症发生在按饮酒量分层的组中。我们将进一步确定每组的医疗费用。尽管有一半的美国成年人饮酒，但人们对这种潜在的可改变的健康行为如何影响糖尿病患者中除冠心病以外的并发症的发生率知之甚少。我们的研究目的是：1)评估基线饮酒(平均每日摄入量、饮酒频率)与糖尿病并发症(心肌梗死、中风、充血性心力衰竭、终末期肾病、下肢截肢、增殖性视网膜病变、急性代谢事件)的发生率以及长达11年的随访期间全因死亡率之间的关系；2)确定种族、性别或年龄是否改变了任何已观察到的饮酒与糖尿病并发症之间的关联；3)调查可能与饮酒和糖尿病并发症发生率相关的解释因素；4)确定医疗成本(总成本；门诊部、急诊科和药房成本；住院费用)和5)评估 内源性偏向，在不同饮酒水平的患者之间。使用队列研究设计，我们将评估在1994-1997年间接受调查的65,996名糖尿病患者的结果，并从那时起进行前瞻性跟踪。我们庞大的、不同种族的队列；通过自动化数据库完全捕获结果；以及对临床状态和其他假定的混杂变量的广泛表征，为研究饮酒在糖尿病并发症发生率中的作用提供了独特的机会。鉴于对这些流行病学关系的不完全了解，酒精的普遍使用，以及与糖尿病相关的日益增加的公共健康和经济负担，这些研究结果将具有重要的公共卫生意义。

DESCRIPTION (provided by applicant): This proposal will evaluate differences in the incidence of diabetes complications and health care costs attributable to alcohol consumption in a large, multiethnic, well-characterized cohort of 65,996 patients with diabetes who receive medical care in an integrated, managed care setting, Kaiser Permanente Northern California. We propose to determine incidence of diabetic complications and all-cause mortality, occurring in groups stratified by alcohol consumption, during up to 11 years follow-up. We will further determine health care costs in each group. Despite the fact that half of U.S. adults consume alcohol, little is known about how this potentially modifiable health behavior affects incidence of complications other than coronary heart disease among people with diabetes. Our study aims are: 1) to evaluate the associations between baseline alcohol consumption (average daily intake, frequency of consumption) and incidence of diabetes complications (myocardial infarction, stroke, congestive heart failure, end-stage renal disease, lower extremity amputation, proliferative retinopathy, acute metabolic events) and all-cause mortality during up to 11 years of follow-up; 2) to determine if ethnicity, gender, or age modify any observed associations between alcohol intake and diabetes complications; 3) to investigate explanatory factors that may link alcohol consumption and diabetes complication incidence rate; 4) to determine the costs of health care (total costs; outpatient, emergency department, and pharmacy costs; hospitalization costs) and 5) to evaluate endogeneity bias, among patients with different levels of alcohol consumption. Using a cohort study design, we will assess these outcomes in 65,996 patients with diabetes who were surveyed in 1994-1997 and have been followed prospectively since then. Our large, ethnically diverse cohort; complete capture of outcomes through automated databases; and extensive characterization of clinical status and other putative confounding variables provides a unique opportunity to study the role of alcohol consumption in the incidence of diabetes complications. Given the incomplete understanding of these epidemiologic relationships, the common use of alcohol, and the increasing public health and economic burden associated with diabetes, these study findings will have important public health significance.