Saydah Sharon H, Eberhardt Mark S, Loria Catherine M, Brancati Frederick L
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Am J Epidemiol. 2002 Oct 15;156(8):714-9. doi: 10.1093/aje/kwf111.
Diabetes is a well-established cause of cardiovascular disease (CVD) and all-cause mortality. The burden of death attributable to diabetes in the United States is not well quantified, particularly with regard to age. The authors analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II) (1976-1980) and the NHANES II Mortality Study, in which a nationally representative cohort of 9,250 adults aged 30-75 years was followed for 12-16 years, to determine all-cause and cause-specific mortality. Overall, between 1976 and 1980, the prevalence of diagnosed diabetes was 4.3%. By 1992, the relative hazard of all-cause mortality was 1.9 (95% confidence interval: 1.5, 2.3), and the population attributable risk (PAR) was 3.6%. The relative hazard of CVD mortality was 2.3 (95% confidence interval: 1.8, 2.8), and the PAR was 5.2%. Including participants with undiagnosed diabetes in the estimates increased the PAR for all-cause mortality to 5.1% and that for CVD mortality to 6.8%. Women had a higher prevalence of diagnosed diabetes than men and a greater relative hazard of death than nondiabetic women, leading to a higher PAR for women (3.8% for all causes and 7.3% for CVD) versus men (3.3% for all causes and 3.8% for CVD). These data suggest that diabetes accounts for at least 3.6% of all deaths and 5.2% of CVD deaths in US adults. Improvements in diabetes prevention and treatment should produce noticeable effects on US life expectancy.
糖尿病是心血管疾病（CVD）和全因死亡率的一个公认病因。在美国，可归因于糖尿病的死亡负担尚未得到很好的量化，尤其是在年龄方面。作者分析了第二次全国健康和营养检查调查（NHANES II）（1976 - 1980年）以及NHANES II死亡率研究的数据，在该研究中，对9250名年龄在30 - 75岁的具有全国代表性的成年人队列进行了12 - 16年的随访，以确定全因死亡率和特定病因死亡率。总体而言，在1976年至1980年期间，确诊糖尿病的患病率为4.3%。到1992年，全因死亡率的相对风险为1.9（95%置信区间：1.5，2.3），人群归因风险（PAR）为3.6%。CVD死亡率的相对风险为2.3（95%置信区间：1.8，2.8），PAR为5.2%。在估计中纳入未确诊糖尿病的参与者后，全因死亡率的PAR增加到5.1%，CVD死亡率的PAR增加到6.8%。女性确诊糖尿病的患病率高于男性，且死亡的相对风险高于非糖尿病女性，导致女性的PAR高于男性（全因3.8%，CVD 7.3%）（男性全因3.3%，CVD 3.8%）。这些数据表明，糖尿病在美国成年人的所有死亡中至少占3.6%，在CVD死亡中占5.2%。糖尿病预防和治疗的改善应会对美国的预期寿命产生显著影响。
