Department of Health Care Management, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
BMC Public Health. 2011 Dec 23;11:953. doi: 10.1186/1471-2458-11-953.
Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults.
We analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2.
The crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning.
Our results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.
糖尿病与老年人功能下降的风险增加有关。很少有研究调查糖尿病患者功能下降对其超额死亡风险的贡献。本研究旨在探讨糖尿病与不同程度的功能下降相结合如何影响老年人的 7 年死亡率。
我们分析了来自台湾全国代表性的 65 岁及以上人群的 2001 年国家健康访谈调查数据。共有 1873 名参与者参与了 2002-2008 年的随访，其中 286 名（15.3%）有经医生确认的糖尿病病史。参与者分为三个功能状态组：（1）高功能-日常生活活动（ADL）、工具性日常生活活动（IADL）或身体功能不受限制；（2）低功能-至少有一项 ADL 受限；（3）中功能-介于前两组之间的所有参与者。
糖尿病患者的粗死亡率为每 1000 人年 52.7 例，非糖尿病患者为每 1000 人年 34.1 例。调整其他因素后，高功能人群中，糖尿病本身与死亡率增加无关。然而，在中功能人群中，糖尿病本身的死亡风险比（HR）为 1.90（95%CI=[1.02-3.53]），在低功能人群中为 3.67（95%CI=[1.55-8.69]）。糖尿病和一种或多种其他慢性疾病的存在与中功能人群的死亡率 HR 为 2.46（95%CI=[1.61-3.77]）和低功能人群的死亡率 HR 为 4.03（95%CI=[2.31-7.03]）相关。
我们的结果表明，在高功能人群中，糖尿病与死亡率增加无关。功能下降对糖尿病患者的死亡率存在梯度效应。此外，在有其他慢性疾病的参与者中，功能下降与糖尿病老年患者的死亡率负担增加相关。这些发现强调了预防心血管疾病发病率和维持功能能力对于降低糖尿病老年患者的死亡风险的重要性。
