Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
BMC Public Health. 2018 Dec 3;18(1):1331. doi: 10.1186/s12889-018-6265-0.
Previous studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations.
Data of persons aged 30-79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008-2012, n = 2539) and KORA-F4 (South Germany, 2006-2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population.
The prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11-2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33-2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01-1.78).
This study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.
先前的研究发现，2 型糖尿病在德国东北部和南部的患病率和发病率存在地域差异。本研究旨在探讨 2 型糖尿病患者和一般人群的大血管疾病是否也存在地域差异。另一个目的是探讨大血管并发症的传统危险因素是否可以解释这些地域差异。
对来自两项区域性基于人群的研究的数据进行了分析，分别是 SHIP-TREND（德国东北部，2008-2012 年，n=2539）和 KORA-F4（德国南部，2006-2008 年，n=2932）。大血管疾病定义为自我报告的既往心肌梗死、中风或冠状动脉造影。采用多变量逻辑回归估计 2 型糖尿病患者和一般人群中大血管疾病的患病率的优势比（OR）和 95%置信区间（CI）。
2 型糖尿病患者和一般人群中大血管疾病的患病率在德国东北部（SHIP-TREND：32.8%和 12.0%）明显高于德国南部（KORA-F4：24.9%和 8.8%）。校正性别、年龄、体重指数、高血压、血脂异常和吸烟因素后，与德国南部相比，2 型糖尿病患者在德国东北部发生大血管疾病的风险为 1.66（95%CI：1.11-2.49）。在一般人群中，与 KORA-F4 参与者相比，SHIP-TREND 参与者发生大血管疾病的风险也显著增加（OR=1.63，95%CI：1.33-2.00）。排除冠状动脉造影（仅心肌梗死或中风）后，所有模型中的 OR 均降低，但在一般人群的年龄和性别调整模型中，SHIP-TREND 和 KORA-F4 参与者之间的差异仍然显著（OR=1.34，95%CI：1.01-1.78）。
本研究提供了大血管疾病存在地域差异的证据，这不能用传统的危险因素来解释。需要进一步研究其他危险因素，如区域贫困或医疗服务的地理差异。
