美国有和无诊断糖尿病的成年人特定病因死亡率趋势：基于全国调查和生命统计数据的流行病学分析。

Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data.

机构信息

Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA.

出版信息

Lancet. 2018 Jun 16;391(10138):2430-2440. doi: 10.1016/S0140-6736(18)30314-3. Epub 2018 May 18.

DOI:10.1016/S0140-6736(18)30314-3

PMID:29784146

Abstract

BACKGROUND

Large reductions in diabetes complications have altered diabetes-related morbidity in the USA. It is unclear whether similar trends have occurred in causes of death.

METHODS

Using data from the National Health Interview Survey Linked Mortality files from 1985 to 2015, we estimated age-specific death rates and proportional mortality from all causes, vascular causes, cancers, and non-vascular, non-cancer causes among US adults by diabetes status.

FINDINGS

From 1988-94, to 2010-15, all-cause death rates declined by 20% every 10 years among US adults with diabetes (from 23·1 [95% CI 20·1-26·0] to 15·2 [14·6-15·8] per 1000 person-years), while death from vascular causes decreased 32% every 10 years (from 11·0 [9·2-12·2] to 5·2 [4·8-5·6] per 1000 person-years), deaths from cancers decreased 16% every 10 years (from 4·4 [3·2-5·5] to 3·0 [2·8-3·3] per 1000 person-years), and the rate of non-vascular, non-cancer deaths declined by 8% every 10 years (from 7·7 [6·3-9·2] to 7·1 [6·6-7·5]). Death rates also declined significantly among people without diagnosed diabetes for all four major mortality categories. However, the declines in death rates were significantly greater among people with diabetes for all-causes (p<0·0001), vascular causes (p=0·0214), and non-vascular, non-cancer causes (p<0·0001), as differences in all-cause and vascular disease death between people with and without diabetes were reduced by about a half. Among people with diabetes, all-cause mortality rates declined most in men and adults aged 65-74 years of age, and there was no decline in death rates among adults aged 20-44 years. The different magnitude of changes in cause-specific mortality led to large changes in the proportional mortality. The proportion of total deaths among adults with diabetes from vascular causes declined from 47·8% (95% CI 38·9-58·8) in 1988-94 to 34·1% (31·4-37·1) in 2010-15; this decline was offset by large increases in the proportion of deaths from non-vascular, non-cancer causes, from 33·5% (26·7-42·1) to 46·5% (43·3-50·0). The proportion of deaths caused by cancer was relatively stable over time, ranging from 16% to 20%.

INTERPRETATION

Declining rates of vascular disease mortality are leading to a diversification of forms of diabetes-related mortality with implications for clinical management, prevention, and disease monitoring.

FUNDING

None.

摘要

背景

美国糖尿病并发症的大量减少改变了与糖尿病相关的发病率。目前尚不清楚在死因方面是否出现了类似的趋势。

方法

我们使用了 1985 年至 2015 年全国健康访谈调查（National Health Interview Survey）链接死亡率文件的数据，根据糖尿病状况，估计了美国成年人的全因、血管原因、癌症和非血管非癌症死因的特定年龄死亡率和比例死亡率。

结果

从 1988-94 年到 2010-15 年，美国成年人中糖尿病患者的全因死亡率每 10 年下降 20%（从 23.1[95%CI 20.1-26.0]降至 15.2[14.6-15.8]每 1000 人年），而血管原因死亡率每 10 年下降 32%（从 11.0[9.2-12.2]降至 5.2[4.8-5.6]每 1000 人年），癌症死亡率每 10 年下降 16%（从 4.4[3.2-5.5]降至 3.0[2.8-3.3]每 1000 人年），非血管非癌症死亡率每 10 年下降 8%（从 7.7[6.3-9.2]降至 7.1[6.6-7.5]每 1000 人年）。在没有确诊糖尿病的人群中，这四类主要死因的死亡率也显著下降。然而，在糖尿病患者中，所有原因（p<0.0001）、血管原因（p=0.0214）和非血管非癌症原因（p<0.0001）的死亡率下降幅度明显更大，糖尿病患者和无糖尿病患者之间的全因和血管疾病死亡率差异减少了一半左右。在糖尿病患者中，全因死亡率下降幅度最大的是男性和 65-74 岁人群，而 20-44 岁成年人的死亡率没有下降。特定病因死亡率的变化幅度不同导致了比例死亡率的巨大变化。糖尿病患者的血管原因死亡率占总死亡人数的比例从 1988-94 年的 47.8%（95%CI 38.9-58.8）降至 2010-15 年的 34.1%（31.4-37.1）；这一下降被非血管非癌症原因死亡比例的大幅增加所抵消，从 33.5%（26.7-42.1）增加到 46.5%（43.3-50.0）。癌症导致的死亡比例在一段时间内相对稳定，在 16%到 20%之间。