Gregg Edward W, Gu Qiuping, Cheng Yiling J, Narayan K M Venkat, Cowie Catherine C
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, USA.
Ann Intern Med. 2007 Aug 7;147(3):149-55. doi: 10.7326/0003-4819-147-3-200708070-00167. Epub 2007 Jun 18.
Whether mortality rates among diabetic adults or excess mortality associated with diabetes in the United States has declined in recent decades is not known.
To examine whether all-cause and cardiovascular disease mortality rates have declined among the U.S. population with and without self-reported diabetes.
Comparison of 3 consecutive, nationally representative cohorts.
Population-based health surveys (National Health and Nutrition Examination Surveys I, II, and III) with mortality follow-up assessment.
Survey participants age 35 to 74 years with and without diabetes.
Diabetes was determined by self-report for each survey (1971-1975, 1976-1980, and 1988-1994), and mortality rates were determined through 1986, 1992, and 2000 for the 3 surveys, respectively.
Among diabetic men, the all-cause mortality rate decreased by 18.2 annual deaths per 1000 persons (from 42.6 to 24.4 annual deaths per 1000 persons; P = 0.03) between 1971 to 1986 and 1988 to 2000, accompanying decreases in the nondiabetic population. Trends for cardiovascular disease mortality paralleled those of all-cause mortality, with 26.4 annual deaths per 1000 persons in 1971 to 1986 and 12.8 annual deaths per 1000 persons in 1988 to 2000 (P = 0.06). Among women with diabetes, however, neither all-cause nor cardiovascular disease mortality declined between 1971 to 1986 and 1988 to 2000, and the all-cause mortality rate difference between diabetic and nondiabetic women more than doubled (from a difference of 8.3 to 18.2 annual deaths per 1000 persons). The difference in all-cause mortality rates by sex among people with diabetes in 1971 to 1986 were essentially eliminated in 1988 to 2000.
Diabetes was assessed by self-report, and statistical power to examine the factors explaining mortality trends was limited.
Progress in reducing mortality rates among persons with diabetes has been limited to men. Diabetes continues to greatly increase the risk for death, particularly among women.
近几十年来，美国糖尿病成年人的死亡率或与糖尿病相关的额外死亡率是否下降尚不清楚。
研究美国有和没有自我报告糖尿病的人群中全因死亡率和心血管疾病死亡率是否下降。
对连续3个具有全国代表性的队列进行比较。
基于人群的健康调查（第一次、第二次和第三次全国健康和营养检查调查）并进行死亡率随访评估。
年龄在35至74岁之间有和没有糖尿病的调查参与者。
每次调查（1971 - 1975年、1976 - 1980年和1988 - 1994年）通过自我报告确定糖尿病，分别通过1986年、1992年和2000年确定3次调查的死亡率。
在糖尿病男性中，1971年至1986年与1988年至2000年期间，全因死亡率从每1000人每年42.6例死亡降至每1000人每年24.4例死亡，每1000人每年减少18.2例死亡（P = 0.03），非糖尿病人群也有下降。心血管疾病死亡率趋势与全因死亡率平行，1971年至1986年为每1000人每年26.4例死亡，1988年至2000年为每1000人每年12.8例死亡（P = 0.06）。然而，在糖尿病女性中，1971年至1986年与1988年至2000年期间，全因死亡率和心血管疾病死亡率均未下降，糖尿病女性与非糖尿病女性的全因死亡率差异增加了一倍多（从每1000人每年相差8.3例死亡增至18.2例死亡）。1971年至1986年糖尿病患者中按性别划分的全因死亡率差异在1988年至2000年基本消除。
糖尿病通过自我报告评估，且用于研究解释死亡率趋势因素的统计效力有限。
降低糖尿病患者死亡率的进展仅限于男性。糖尿病继续大幅增加死亡风险，尤其是在女性中。
