From the, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
J Intern Med. 2020 Jan;287(1):78-86. doi: 10.1111/joim.12984. Epub 2019 Oct 28.
There is limited evidence linking type 2 diabetes (T2D) to influenza-related complications.
To test a set of research questions relating to pandemic influenza vaccination, hospitalization and mortality in people with and without T2D.
In this population-based cohort study, we linked individual-level data from several national registers for all Norwegian residents aged 30 years or more as of January 2009. People with or without T2D at baseline (n = 2 992 228) were followed until December 2013. We used Cox regression to estimate adjusted hazard ratios (aHRs).
Pandemic influenza hospitalization was more common in individuals with T2D (aHR = 2.46, 95% CI 2.04-2.98). The mortality hazard ratio associated with hospitalization for pandemic influenza was lower in people with T2D (aHR = 1.82, 95% CI 1.21-2.74) than in those without T2D (aHR = 3.89, 95% CI 3.27-4.62). The same pattern was observed when restricting to 90-day mortality (aHR = 3.89, 95% CI 1.25-12.06 amongst those with T2D and aHR = 10.79, 95% CI 7.23-16.10 amongst those without T2D). The rate of hospitalization for pandemic influenza was 78% lower in those vaccinated compared to nonvaccinated amongst people with T2D (aHR = 0.22, 95% CI 0.11-0.39), whilst the corresponding estimate for those without T2D was 59% lower (aHR = 0.41, 95% CI 0.33-0.52). Mortality was 25% lower in those vaccinated compared to nonvaccinated amongst people with T2D (aHR = 0.75, 95% CI 0.73-0.77), whilst the corresponding estimate for those without T2D was 9% (aHR = 0.91, 95% CI 0.90-0.92).
There may have been a lower threshold for pandemic influenza hospitalization for people with T2D, rather than more severe influenza infection. Our combined results support the importance of influenza vaccination amongst people with T2D, especially during pandemics.
目前仅有有限的证据表明 2 型糖尿病（T2D）与流感相关并发症之间存在关联。
本研究旨在检验一组与大流行性流感疫苗接种、住院和 T2D 患者与非 T2D 患者死亡率相关的研究问题。
在这项基于人群的队列研究中，我们将来自几个全国性登记处的个体水平数据与截至 2009 年 1 月年龄在 30 岁及以上的所有挪威居民进行了关联。在基线时患有或未患有 T2D（n=2992228）的患者随访至 2013 年 12 月。我们使用 Cox 回归来估计调整后的危险比（aHR）。
患有 T2D 的个体发生大流行性流感住院的情况更为常见（aHR=2.46，95%CI 2.04-2.98）。与未患有 T2D 的个体相比（aHR=3.89，95%CI 3.27-4.62），患有 T2D 的个体因大流行性流感住院而死亡的风险比（aHR=1.82，95%CI 1.21-2.74）较低。当将其限制为 90 天死亡率时，也观察到了相同的模式（aHR=3.89，95%CI 1.25-12.06 为 T2D 患者，aHR=10.79，95%CI 7.23-16.10 为非 T2D 患者）。与未接种疫苗的患者相比，接种疫苗的 T2D 患者的大流行性流感住院率降低了 78%（aHR=0.22，95%CI 0.11-0.39），而未接种疫苗的 T2D 患者的相应估计值降低了 59%（aHR=0.41，95%CI 0.33-0.52）。与未接种疫苗的患者相比，接种疫苗的 T2D 患者的死亡率降低了 25%（aHR=0.75，95%CI 0.73-0.77），而非 T2D 患者的相应估计值降低了 9%（aHR=0.91，95%CI 0.90-0.92）。
T2D 患者的大流行性流感住院阈值可能较低，而不是流感感染更严重。我们的综合结果支持在 T2D 患者中接种流感疫苗的重要性，尤其是在大流行期间。
