Yokokawa Hirohide, Goto Aya, Abe Yoko, Suzuki Sonoko, Yasumura Seiji
Department of Public Health, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.
Health Soc Care Community. 2008 Dec;16(6):614-20. doi: 10.1111/j.1365-2524.2008.00787.x. Epub 2008 May 13.
Despite the significant adverse health consequences of diabetes, data on lifestyle characteristics and mortality among the Japanese with diabetes are limited. Our objective was to investigate the lifestyles of Japanese community residents with self-reported diabetes and their 3-year total mortality. Our cohort was 7178 randomly selected residents aged 30-79 years in Nihonmatsu City, Fukushima Prefecture, Japan; 5187 responded to the survey (72% response rate) and were followed for 3 years. Baseline data were collected using questionnaires in December 2002, and deaths were monitored monthly. Only 19% of women and 4% of men followed six to seven of Breslow's seven health practices. The percentage of people with self-reported diabetes was 4.2%[95% confidence interval (CI), 3.4-5.1%] for women and 7.9% (95% CI, 6.8-9.1%) for men, and the 3-year total mortality was 1.4% (95% CI, 1.0-1.9%) for women and 3.1% (95% CI, 2.4-3.8%) for men. Factors associated with 3-year mortality were fair or poor subjective health [odds ratio (OR) = 3.1, 95% CI 1.7-5.5] and self-reported diabetes (OR = 2.3, 95% CI 1.1-4.9) in a logistic regression controlling for age and gender. In stratified analyses, 3-year mortality of those with diabetes was significantly higher than those without the disease among men and those aged under 65. Those with diabetes were more likely to have self-reported comorbidities, high blood pressure and report poor subjective health regardless of age and gender, and healthier lifestyles among the women and those aged under 65. Our results support the need for community-based primary prevention measures to improve the lifestyles of residents, along with secondary prevention approaches to monitor those with diabetes for complications and to give them lifestyle instructions.
尽管糖尿病会对健康造成严重的不良后果，但关于日本糖尿病患者的生活方式特征和死亡率的数据却很有限。我们的目标是调查日本社区中自我报告患有糖尿病的居民的生活方式及其3年全因死亡率。我们的队列是日本福岛县二本松市7178名年龄在30 - 79岁之间的随机选取居民；5187人回应了调查（回应率为72%），并随访了3年。2002年12月通过问卷调查收集基线数据，每月监测死亡情况。只有19%的女性和4%的男性遵循了布雷斯洛七种健康行为中的六种到七种。自我报告患有糖尿病的女性比例为4.2%[95%置信区间（CI），3.4 - 5.1%]，男性为7.9%（95%CI，6.8 - 9.1%），3年全因死亡率女性为1.4%（95%CI，1.0 - 1.9%），男性为3.1%（95%CI，2.4 - 3.8%）。在控制年龄和性别的逻辑回归分析中，与3年死亡率相关的因素是主观健康状况一般或较差[优势比（OR）= 3.1，95%CI 1.7 - 5.5]以及自我报告患有糖尿病（OR = 2.3，95%CI 1.1 - 4.9）。在分层分析中，男性和65岁以下人群中，患有糖尿病者的3年死亡率显著高于未患糖尿病者。无论年龄和性别，患有糖尿病者更有可能自我报告有合并症、高血压且主观健康状况较差，而女性和65岁以下人群的生活方式更健康。我们的结果支持需要采取基于社区的一级预防措施来改善居民的生活方式，同时采取二级预防方法来监测糖尿病患者的并发症情况并给予他们生活方式指导。
