Stokes Andrew, Preston Samuel H
Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2017 Jan 25;12(1):e0170219. doi: 10.1371/journal.pone.0170219. eCollection 2017.
The goal of this research was to identify the fraction of deaths attributable to diabetes in the United States.
We estimated population attributable fractions (PAF) for cohorts aged 30-84 who were surveyed in the National Health Interview Survey (NHIS) between 1997 and 2009 (N = 282,322) and in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010 (N = 21,814). Cohort members were followed prospectively for mortality through 2011. We identified diabetes status using self-reported diagnoses in both NHIS and NHANES and using HbA1c in NHANES. Hazard ratios associated with diabetes were estimated using Cox model adjusted for age, sex, race/ethnicity, educational attainment, and smoking status.
We found a high degree of consistency between data sets and definitions of diabetes in the hazard ratios, estimates of diabetes prevalence, and estimates of the proportion of deaths attributable to diabetes. The proportion of deaths attributable to diabetes was estimated to be 11.5% using self-reports in NHIS, 11.7% using self-reports in NHANES, and 11.8% using HbA1c in NHANES. Among the sub-groups that we examined, the PAF was highest among obese persons at 19.4%. The proportion of deaths in which diabetes was assigned as the underlying cause of death (3.3-3.7%) severely understated the contribution of diabetes to mortality in the United States.
Diabetes may represent a more prominent factor in American mortality than is commonly appreciated, reinforcing the need for robust population-level interventions aimed at diabetes prevention and care.
本研究的目标是确定在美国可归因于糖尿病的死亡比例。
我们估计了1997年至2009年在国家健康访谈调查（NHIS）（N = 282,322）以及1999年至2010年在国家健康和营养检查调查（NHANES）（N = 21,814）中接受调查的30 - 84岁队列人群的人群归因分数（PAF）。对队列成员进行前瞻性随访直至2011年的死亡率情况。我们在NHIS和NHANES中均使用自我报告的诊断结果来确定糖尿病状态，在NHANES中还使用糖化血红蛋白（HbA1c）来确定。使用经年龄、性别、种族/族裔、教育程度和吸烟状况调整的Cox模型估计与糖尿病相关的风险比。
我们发现，在风险比、糖尿病患病率估计值以及可归因于糖尿病的死亡比例估计值方面，数据集与糖尿病定义之间具有高度一致性。使用NHIS中的自我报告，可归因于糖尿病的死亡比例估计为11.5%；使用NHANES中的自我报告为11.7%；使用NHANES中的HbA1c为11.8%。在我们研究的亚组中，肥胖人群的PAF最高，为19.4%。将糖尿病列为根本死因的死亡比例（3.3 - 3.7%）严重低估了糖尿病对美国死亡率的影响。
糖尿病在美国死亡率中可能是一个比通常认为的更为突出的因素，这进一步凸显了针对糖尿病预防和护理采取强有力的人群层面干预措施的必要性。
