McEwen Laura N, Kim Catherine, Karter Andrew J, Haan Mary N, Ghosh Debashis, Lantz Paula M, Mangione Carol M, Thompson Theodore J, Herman William H
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Diabetes Care. 2007 Jul;30(7):1736-41. doi: 10.2337/dc07-0305. Epub 2007 Apr 27.
We sought to examine demographic, socioeconomic, and biological predictors of all-cause, cardiovascular, and noncardiovascular mortality in patients with diabetes.
Survey, medical record, and administrative data were obtained from 8,733 participants in the Translating Research Into Action for Diabetes Study, a multicenter, prospective, observational study of diabetes care in managed care. Data on deaths (n = 791) and cause of death were obtained from the National Death Index after 4 years. Predictors examined included age, sex, race, education, income, duration, and treatment of diabetes, BMI, smoking, microvascular and macrovascular complications, and comorbidities.
Predictors of adjusted all-cause mortality included older age (hazard ratio [HR] 1.04 [95% CI 1.03-1.05]), male sex (1.57 [1.35-1.83]), lower income (< $15,000 vs. > $75,000, HR 1.82 [1.30-2.54]; $15,000-$40,000 vs. > $75,000, HR 1.58 [1.15-2.17]), longer duration of diabetes (> or = 9 years vs. < 9 years, HR 1.20 [1.02-1.41]), lower BMI (< 26 vs. 26-30 kg/m2, HR 1.43 [1.13-1.69]), smoking (1.44 [1.20-1.74]), nephropathy (1.46 [1.23-2.73]), macrovascular disease (1.46 [1.23-1.74]), and greater Charlson index (> or = 2-3 vs. < 1, HR 2.01 [1.04-3.90]; > or = 3 vs. < 1, HR 4.38 [2.26-8.47]). The predictors of cardiovascular and noncardiovascular mortality were different. Macrovascular disease predicted cardiovascular but not noncardiovascular mortality.
Among people with diabetes and access to medical care, older age, male sex, smoking, and renal disease are important predictors of mortality. Even within an insured population, socioeconomic circumstance is an important independent predictor of health.
我们试图研究糖尿病患者全因死亡率、心血管疾病死亡率和非心血管疾病死亡率的人口统计学、社会经济和生物学预测因素。
从“将糖尿病研究转化为行动”研究中的8733名参与者获取调查、病历和管理数据，该研究是一项多中心、前瞻性、观察性的糖尿病管理护理研究。4年后从国家死亡指数获取死亡数据（n = 791）和死因数据。所研究的预测因素包括年龄、性别、种族、教育程度、收入、糖尿病病程及治疗情况、体重指数（BMI）、吸烟、微血管和大血管并发症以及合并症。
校正后全因死亡率的预测因素包括年龄较大（风险比[HR]1.04[95%置信区间1.03 - 1.05]）、男性（1.57[1.35 - 1.83]）、收入较低（<15,000美元对比>75,000美元，HR 1.82[1.30 - 2.54]；15,000 - 40,000美元对比>75,000美元，HR 1.58[1.15 - 2.17]）、糖尿病病程较长（≥9年对比<9年，HR 1.20[1.02 - 1.41]）、BMI较低（<26对比26 - 30 kg/m²，HR 1.43[1.13 - 1.69]）、吸烟（1.44[1.20 - 1.74]）、肾病（1.46[1.23 - 2.73]）、大血管疾病（1.46[1.23 - 1.74]）以及查尔森指数较高（≥2 - 3对比<1，HR 2.01[1.04 - 3.90]；≥3对比<1，HR 4.38[2.26 - 8.47]）。心血管疾病和非心血管疾病死亡率的预测因素有所不同。大血管疾病可预测心血管疾病死亡率，但不能预测非心血管疾病死亡率。
在有医疗服务可及性的糖尿病患者中，年龄较大、男性、吸烟和肾病是死亡率的重要预测因素。即使在参保人群中，社会经济状况也是健康的重要独立预测因素。
