Scottish Collaboration for Public Health Research and Policy, MRC Human Genetics Unit, Western General Hospital, Edinburgh, UK.
Diabetologia. 2012 Nov;55(11):2938-45. doi: 10.1007/s00125-012-2667-1. Epub 2012 Aug 15.
AIMS/HYPOTHESIS: The aim of this study was to explore the relationships between type 2 diabetes mellitus, area-based socioeconomic status (SES) and cardiovascular disease mortality in Scotland.
We used an area-based measure of SES, Scottish national diabetes register data linked to mortality records, and general population cause-specific mortality data to investigate the relationships between SES, type 2 diabetes and mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CbVD), for 2001-2007. We used negative binomial regression to obtain age-adjusted RRs of mortality (by sex), comparing people with type 2 diabetes with the non-diabetic population.
Among 216,652 people aged 40 years or older with type 2 diabetes (980,687 person-years), there were 10,554 IHD deaths and 4,378 CbVD deaths. Age-standardised mortality increased with increasing deprivation, and was higher among men. IHD mortality RRs were highest among the least deprived quintile and lowest in the most deprived quintile (men: least deprived, RR 1.94 [95% CI 1.61, 2.33]; most deprived, RR 1.46 [95% CI 1.23, 1.74]) and were higher in women than men (women: least deprived, RR 2.84 [95% CI 2.12, 3.80]; most deprived, RR 2.04 [95% CI 1.55, 2.69]). A similar, weaker, pattern was observed for cerebrovascular mortality.
CONCLUSIONS/INTERPRETATION: Absolute risk of cardiovascular mortality is higher in people with diabetes than in the non-diabetic population and increases with increasing deprivation. The relative impact of diabetes on cardiovascular mortality differs by SES, and further efforts to reduce cardiovascular risk both in deprived groups and people with diabetes are required. Prevention of diabetes may reduce socioeconomic health inequalities.
目的/假设：本研究旨在探索 2 型糖尿病、基于地区的社会经济地位（SES）与苏格兰心血管疾病死亡率之间的关系。
我们使用基于地区的 SES 衡量标准、苏格兰国家糖尿病登记处的数据与死亡率记录以及一般人群的特定病因死亡率数据，来研究 SES、2 型糖尿病与缺血性心脏病（IHD）和脑血管疾病（CbVD）死亡率之间的关系，研究时间为 2001 年至 2007 年。我们使用负二项回归获得了年龄调整后的死亡率（按性别）的相对危险度（RR），并将患有 2 型糖尿病的人与非糖尿病人群进行了比较。
在 216652 名年龄在 40 岁或以上患有 2 型糖尿病的人群（980687 人年）中，有 10554 例 IHD 死亡和 4378 例 CbVD 死亡。年龄标准化死亡率随贫困程度的增加而增加，且男性的死亡率更高。IHD 死亡率 RR 在最不贫困的五分位数中最高，在最贫困的五分位数中最低（男性：最不贫困，RR 1.94[95%CI 1.61，2.33]；最贫困，RR 1.46[95%CI 1.23，1.74]），且女性的 RR 高于男性（女性：最不贫困，RR 2.84[95%CI 2.12，3.80]；最贫困，RR 2.04[95%CI 1.55，2.69]）。对于脑血管死亡率，也观察到了类似的、较弱的模式。
结论/解释：与非糖尿病人群相比，糖尿病患者的心血管死亡率的绝对风险更高，且随着贫困程度的增加而增加。糖尿病对心血管死亡率的相对影响因 SES 而异，需要在贫困人群和糖尿病患者中进一步努力降低心血管风险。预防糖尿病可能会减少社会经济健康不平等。
