Narayanan Meera L, Schraer Cynthia D, Bulkow Lisa R, Koller Kathryn R, Asay Elvin, Mayer Ann Marie, Raymer Terry W
Alaska Native Medical Center Diabetes Program (ANC-DIA), Anchorage, Alaska 99508, USA.
Int J Circumpolar Health. 2010 Jun;69(3):236-52. doi: 10.3402/ijch.v69i3.17618. Epub 2010 May 25.
To examine trends in diabetes prevalence, incidence, complications and mortality between 1985 and 2006 among Alaska Native people.
We used data from the population-based Alaska Native Diabetes Registry, which includes all people who receive care in the Alaska Tribal Health System.
We compared the periods of 1986-1990 and 2002-2006 for diabetes-related amputations, renal replacement and mortality using Poisson regression. Complications and mortality data were examined for trends using Poisson regression. Survival analyses for those diagnosed since 31 December 1985 were performed using the Cox proportional hazard model.
Age-adjusted diabetes prevalence increased from 17.3 in 1985 to 47.6/1,000 in 2006. The number of Alaska Native people living in Alaska with diabetes increased from 610 in 1985 to 3,386 in 2006. Diabetes incidence rates have also increased. Comparing age-adjusted rates for the 5-year periods 1986-1990 and 2002-2006, amputations decreased from 5.3 to 2.6/1,000, renal replacement decreased from 3.3 to 1.2/1,000 and mortality decreased from 41.7 to 33.2/1,000. Yearly analyses showed a downward trend for amputations, renal replacement and mortality rates. Survival analyses showed a significantly higher hazard ratio for any amputations, major amputations and renal replacement for the earlier time period compared to the most recent time period.
An increase in risk factors, awareness, funding and case-finding may be contributing to the increase in prevalence and incidence of diagnosed diabetes. While diabetes prevalence and incidence are increasing among Alaska Native people, our results suggest that even in remote, rural areas, complications and mortality can be reduced.
研究1985年至2006年间阿拉斯加原住民糖尿病患病率、发病率、并发症及死亡率的变化趋势。
我们使用了基于人群的阿拉斯加原住民糖尿病登记处的数据，该登记处涵盖了所有在阿拉斯加部落卫生系统接受治疗的人群。
我们使用泊松回归比较了1986 - 1990年和2002 - 2006年期间与糖尿病相关的截肢、肾脏替代治疗及死亡率。使用泊松回归分析并发症和死亡率数据的变化趋势。对1985年12月31日以后确诊的患者，采用Cox比例风险模型进行生存分析。
年龄调整后的糖尿病患病率从1985年的17.3/1000上升至2006年的47.6/1000。居住在阿拉斯加的患有糖尿病的原住民人数从1985年的610人增加至2006年的3386人。糖尿病发病率也有所上升。比较1986 - 1990年和2002 - 2006年这两个5年期间的年龄调整率，截肢率从5.3/1000降至2.6/1000，肾脏替代治疗率从3.3/1000降至1.2/1000，死亡率从41.7/1000降至33.2/1000。年度分析显示截肢、肾脏替代治疗及死亡率呈下降趋势。生存分析表明，与最近时期相比，早期任何截肢、大截肢及肾脏替代治疗的风险比显著更高。
危险因素、意识、资金及病例发现的增加可能导致已确诊糖尿病的患病率和发病率上升。虽然阿拉斯加原住民中糖尿病患病率和发病率在增加，但我们的结果表明，即使在偏远农村地区，并发症和死亡率也可降低。
