社会经济剥夺对2型糖尿病患者糖尿病并发症结局的影响：韩国一项基于全国人群的队列研究。
Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea.
作者信息
Choi Dong-Woo, Lee Sang Ah, Lee Doo Woong, Joo Jae Hong, Han Kyu-Tae, Kim SeungJu, Park Eun-Cheol
机构信息
Department of Public Health, Graduate School, Yonsei University, Seoul, Korea (the Republic of).
Research and Analysis Team, National Health Insurance Corporation Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of).
出版信息
BMJ Open Diabetes Res Care. 2020 Jul;8(1). doi: 10.1136/bmjdrc-2019-000729.
INTRODUCTION
This study aimed to examine the effect of socioeconomic deprivation on the outcomes of diabetes complications in patients with type 2 diabetes mellitus (T2DM).
RESEARCH DESIGN AND METHODS
We conducted a cohort study using claims data and 2005 national census data. We included of 7510 patients newly diagnosed with T2DM from 2004 to 2012 and aged 40 years or above. We excluded participants who had onset of diabetes complications and hospitalization within 1 year after initial onset T2DM, aged less than 40 years and with missing covariates. We used the regional socioeconomic deprivation index and classified study participants into five categories according to the quintile distribution. We calculated the adjusted HR and 95% CI for hospitalization related to diabetes complications and all-cause mortality by applying Cox proportional hazards model and the adjusted subdistribution hazards model.
RESULTS
The percentages of participants in the first quintile (least deprived) to fifth quintile (most deprived) were 27.0%, 27.9%, 19.5%, 14.8%, and 10.8% for socioeconomic deprivation; 25.4%, 28.8%, 32.4%, 34.6%, and 37.6% for hospitalization due to diabetes complications; 1.3%, 2.1%, 2.5%, 2.9%, and 3.6% for deaths from diabetes complications; and 5.7%, 7.2%, 9.7%, 9.7%, and 13.1% for deaths from all causes, respectively. Participants with higher socioeconomic deprivation had a higher HR for hospitalization and mortality from all-cause and diabetes complications. These associations were the strongest among men and participants in their 40s in hospitalization related to diabetes complications, 50s in diabetes complications-specific mortality and 50s and 60s in all-cause mortality.
CONCLUSIONS
Patients with T2DM with high socioeconomic deprivation had higher hospital admission and mortality rates for diabetes complications than those with low deprivation. We cannot fully explain the effect of socioeconomic deprivation on diabetes outcomes. Therefore, further studies are needed in order to find underlying mechanisms for these associations.
引言
本研究旨在探讨社会经济剥夺对2型糖尿病（T2DM）患者糖尿病并发症结局的影响。
研究设计与方法
我们使用索赔数据和2005年全国人口普查数据进行了一项队列研究。我们纳入了2004年至2012年新诊断为T2DM且年龄在40岁及以上的7510名患者。我们排除了在T2DM初次发病后1年内出现糖尿病并发症和住院、年龄小于40岁以及协变量缺失的参与者。我们使用区域社会经济剥夺指数，并根据五分位数分布将研究参与者分为五类。我们通过应用Cox比例风险模型和调整后的子分布风险模型计算与糖尿病并发症相关的住院和全因死亡率的调整后HR及95%CI。
结果
社会经济剥夺方面，第一五分位数（最不贫困）至第五五分位数（最贫困）的参与者百分比分别为27.0%、27.9%、19.5%、14.8%和10.8%；因糖尿病并发症住院方面分别为25.4%、28.8%、32.4%、34.6%和37.6%；糖尿病并发症死亡方面分别为1.3%、2.1%、2.5%、2.9%和3.6%；全因死亡方面分别为5.7%、7.2%、9.7%、9.7%和13.1%。社会经济剥夺程度较高的参与者因全因和糖尿病并发症住院及死亡的HR较高。在与糖尿病并发症相关的住院方面，这些关联在男性和40多岁的参与者中最强；在糖尿病并发症特异性死亡率方面在50多岁的参与者中最强；在全因死亡率方面在50多岁和60多岁的参与者中最强。
结论
社会经济剥夺程度高的T2DM患者比剥夺程度低的患者糖尿病并发症的住院率和死亡率更高。我们无法完全解释社会经济剥夺对糖尿病结局的影响。因此，需要进一步研究以找出这些关联的潜在机制。
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