Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet Diabetes Endocrinol. 2014 Nov;2(11):867-74. doi: 10.1016/S2213-8587(14)70161-5. Epub 2014 Aug 12.
BACKGROUND: Diabetes incidence has increased and mortality has decreased greatly in the USA, potentially leading to substantial changes in the lifetime risk of diabetes. We aimed to provide updated estimates for the lifetime risk of development of diabetes and to assess the effect of changes in incidence and mortality on lifetime risk and life-years lost to diabetes in the USA. METHODS: We incorporated data about diabetes incidence from the National Health Interview Survey, and linked data about mortality from 1985 to 2011 for 598 216 adults, into a Markov chain model to estimate remaining lifetime diabetes risk, years spent with and without diagnosed diabetes, and life-years lost due to diabetes in three cohorts: 1985-89, 1990-99, and 2000-11. Diabetes was determined by self-report and was classified as any diabetes, excluding gestational diabetes. We used logistic regression to estimate the incidence of diabetes and Poisson regression to estimate mortality. FINDINGS: On the basis of 2000-11 data, lifetime risk of diagnosed diabetes from age 20 years was 40·2% (95% CI 39·2-41·3) for men and 39·6% (38·6-40·5) for women, representing increases of 20 percentage points and 13 percentage points, respectively, since 1985-89. The highest lifetime risks were in Hispanic men and women, and non-Hispanic black women, for whom lifetime risk now exceeds 50%. The number of life-years lost to diabetes when diagnosed at age 40 years decreased from 7·7 years (95% CI 6·5-9·0) in 1990-99 to 5·8 years (4·6-7·1) in 2000-11 in men, and from 8·7 years (8·4-8·9) to 6·8 years (6·7-7·0) in women over the same period. Because of the increasing diabetes prevalence, the average number of years lost due to diabetes for the population as a whole increased by 46% in men and 44% in women. Years spent with diabetes increased by 156% in men and 70% in women. INTERPRETATION: Continued increases in the incidence of diagnosed diabetes combined with declining mortality have led to an acceleration of lifetime risk and more years spent with diabetes, but fewer years lost to the disease for the average individual with diabetes. These findings mean that there will be a continued need for health services and extensive costs to manage the disease, and emphasise the need for effective interventions to reduce incidence. FUNDING: None.
背景：美国的糖尿病发病率上升，死亡率大幅下降，这可能导致糖尿病终生风险发生重大变化。我们旨在提供发展为糖尿病的终生风险的最新估计，并评估发病率和死亡率变化对美国糖尿病终生风险和因糖尿病丧失的生命年数的影响。
方法：我们将来自国家健康访谈调查的糖尿病发病率数据与 1985 年至 2011 年的死亡率数据结合起来，将 598216 名成年人的资料纳入一个马尔可夫链模型，以估计三个队列（1985-89 年、1990-99 年和 2000-11 年）中糖尿病的剩余终生风险、患有和不患有确诊糖尿病的年数以及因糖尿病丧失的生命年数。糖尿病通过自我报告确定，且分类为任何糖尿病，不包括妊娠糖尿病。我们使用逻辑回归来估计糖尿病的发病率，使用泊松回归来估计死亡率。
发现：根据 2000-11 年的数据，从 20 岁开始，男性患确诊糖尿病的终生风险为 40.2%（95%CI 39.2-41.3），女性为 39.6%（38.6-40.5），与 1985-89 年相比，分别增加了 20 个百分点和 13 个百分点。终生风险最高的是西班牙裔男性和女性以及非西班牙裔黑人女性，她们现在的终生风险超过了 50%。在 40 岁时被诊断患有糖尿病的患者中，因糖尿病丧失的生命年数从 1990-99 年的 7.7 年（95%CI 6.5-9.0）减少到 2000-11 年的 5.8 年（4.6-7.1）在男性中，而在女性中从 8.7 年（8.4-8.9）减少到 6.8 年（6.7-7.0）。由于糖尿病的患病率持续上升，男性和女性的整体人口因糖尿病丧失的生命年数分别增加了 46%和 44%。男性糖尿病患者的患病时间增加了 156%，女性增加了 70%。
解释：确诊糖尿病发病率的持续上升，加上死亡率的下降，导致终生风险加速上升，患糖尿病的时间延长，但糖尿病患者的平均丧失生命年数减少。这些发现意味着将继续需要医疗保健服务和大量成本来管理这种疾病，并且强调需要有效的干预措施来降低发病率。
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