Population Studies Center, University of Pennsylvania, 3718 Locust Walk, 239 McNeil Building, Philadelphia, PA, 19104-6298, USA.
Popul Health Metr. 2013 Feb 28;11(1):3. doi: 10.1186/1478-7954-11-3.
There is strong evidence on the efficacy of behavioral modification and treatment for reducing diabetes incidence and diabetes-related morbidity and mortality in persons with pre-diabetes and diabetes. But the extent to which the evidence has translated into gains in health in these population sub-groups in the US is unclear. Monitoring national diabetes-related mortality levels over time is important for evaluating the effectiveness of the US health system response to diabetes.
We identified individuals with pre-diabetes and diabetes using Hemoglobin A1c. Two consecutive periods for investigating differences in mortality according to categories of glycemia were derived using nationally representative survey data on US adults ages 35-74 from subsequent rounds of the National Health and Nutrition Examination Survey (1988-1994 and 1999-2002). Age-standardized mortality rates were calculated for individuals with pre-diabetes and diabetes and proportional hazards models were used to assess change in the relative risks of dysglycemia (pre-diabetes and diabetes) adjusting for multiple confounding factors.
Age-standardized mortality rates in individuals with pre-diabetes and diabetes showed no statistically significant change between 1988-2001 and 1999-2006. In individuals with pre-diabetes, mortality rates were 11.19 and 14.02 deaths per 1,000 person-years in the early and later period, respectively. The corresponding values for individuals with diabetes were 20.34 and 20.82 deaths per 1,000 person-years. In contrast, the absolute level of mortality in the normo-glycemic population declined significantly between 1988-2001 and 1999-2006 (7.81 to 6.04; p for difference < 0.05). Adjusting for social and demographic variables, smoking and body mass index in a multivariate analysis, the hazard ratio of dysglycemia increased from 1.62 (95% CI: 1.36-1.93) in 1988-2001 to 2.36 (95% CI: 1.70-3.27) in 1999-2006 (p for difference < 0.05).
We find no evidence of declines in excess mortality in persons with dysglycemia between 1988-2001 and 1999-2006, a result that was robust to adjustment for social and demographic variables, smoking and body mass index. In the context of long-term secular declines in mortality in the US population, our findings suggest that individuals with pre-diabetes and diabetes should be an important focus of future interventions aimed at improving population health in the US.
有强有力的证据表明，行为改变和治疗可以降低糖尿病前期和糖尿病患者的糖尿病发病率和糖尿病相关发病率和死亡率。但在美国，这些人群的健康状况是否因证据转化而有所改善尚不清楚。监测全国范围内与糖尿病相关的死亡率水平，对于评估美国卫生系统对糖尿病的反应效果非常重要。
我们使用糖化血红蛋白（Hemoglobin A1c）确定患有糖尿病前期和糖尿病的个体。使用随后两轮美国 35-74 岁成年人的全国健康和营养检查调查（1988-1994 年和 1999-2002 年）的数据，得出了根据血糖水平类别调查死亡率差异的两个连续时期。为患有糖尿病前期和糖尿病的个体计算了年龄标准化死亡率，并使用多因素混杂因素调整后评估了血糖异常（糖尿病前期和糖尿病）的相对风险变化的比例风险模型。
1988-2001 年和 1999-2006 年期间，患有糖尿病前期和糖尿病的个体的年龄标准化死亡率没有统计学意义上的变化。在糖尿病前期个体中，早期和晚期的死亡率分别为每 1000 人年 11.19 和 14.02 例死亡。糖尿病个体的相应值分别为每 1000 人年 20.34 和 20.82 例死亡。相比之下，1988-2001 年至 1999-2006 年期间，正常血糖人群的死亡率水平显著下降（7.81 至 6.04；p 值<0.05）。在多变量分析中，调整社会人口统计学变量、吸烟和体重指数后，血糖异常的危险比从 1988-2001 年的 1.62（95%可信区间：1.36-1.93）增加到 1999-2006 年的 2.36（95%可信区间：1.70-3.27）（p 值<0.05）。
我们没有发现 1988-2001 年至 1999-2006 年间血糖异常患者的超额死亡率下降的证据，这一结果在调整社会人口统计学变量、吸烟和体重指数后仍然稳健。在美国人口长期的死亡率下降的背景下，我们的研究结果表明，糖尿病前期和糖尿病患者应该成为未来旨在改善美国人口健康的干预措施的重要焦点。
