澳大利亚 1 型和 2 型糖尿病患者的死亡率趋势：1997-2010 年。

Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997-2010.

机构信息

Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

出版信息

Diabetes Care. 2014 Sep;37(9):2579-86. doi: 10.2337/dc14-0096. Epub 2014 Jun 19.

DOI:10.2337/dc14-0096

PMID:24947787

Abstract

OBJECTIVE

With improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods.

RESEARCH DESIGN AND METHODS

A total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate.

RESULTS

For type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (Ptrend < 0.001) and from 3.92 to 3.46 in females (Ptrend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (Ptrend < 0.001) and from 1.56 to 1.22 in females (Ptrend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (Ptrend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (Ptrend < 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively.

CONCLUSIONS

All-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.

摘要

目的

随着心血管疾病（CVD）在糖尿病患者中的发病率的改善，死亡率也可能发生变化。然而，这些趋势可能受到死亡证明中与 CVD 相关的死亡编码实践的影响。我们分析了 13 年来糖尿病患者的死亡率趋势，并根据当前的编码方法量化了 CVD 死亡率的潜在错误分类。

研究设计和方法

1997 年至 2010 年间，全国糖尿病服务计划登记的 1136617 名澳大利亚糖尿病患者与国家死亡索引相链接。相对于澳大利亚人口的超额死亡率报告为标准化死亡率比（SMR）。通过根据根本死因（COD）对 CVD 死亡率进行编码，然后考虑死亡证明第一部分中列出的根本原因和其他原因，确定 CVD 死亡率的潜在错误分类。

结果

对于 1 型糖尿病，男性的 SMR 从 1997 年的 4.20 降至 2010 年的 3.08（Ptrend <0.001），从 3.92 降至 3.46（Ptrend <0.01）。对于 2 型糖尿病，男性的 SMR 从 1.40 降至 1.21（Ptrend <0.001），从 1.56 降至 1.22（Ptrend <0.001）。男性和女性 1 型糖尿病的 CVD 死亡分别从 35.6%降至 31.2%，从 31.5%降至 27.2%（Ptrend <0.001）。对于 2 型糖尿病，男性的 CVD 从 44.5%降至 29.2%，女性的 CVD 从 45.5%降至 31.6%（Ptrend <0.001）。使用传统的编码方法，1 型糖尿病和 2 型糖尿病中分别有~38%和 26%的 CVD 死亡被低估。