Tai Shu-Yu, He Jiun-Shiuan, Kuo Chun-Tung, Kawachi Ichiro
Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.
Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City 801, Taiwan.
J Clin Med. 2020 Sep 18;9(9):3012. doi: 10.3390/jcm9093012.
Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan's nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00-1.07) and 1.15 times (95% CI 1.12-1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban-rural disparities in diabetes-related complications in Taiwan.
尽管城乡地区慢性病的患病率和转归存在差异，但关于糖尿病相关并发症的研究却很匮乏。本研究旨在利用台湾地区全国糖尿病数据库，探讨城市化与糖尿病相关并发症发生之间的关联。共纳入了2000年至2008年间新诊断的380474例2型糖尿病患者，并随访至2013年或直至死亡；经过倾向评分匹配后，纳入31310对进行分析。确定了7种感兴趣的糖尿病相关并发症的发生情况。采用Cox比例风险模型来确定城市、郊区和农村组中事件发生时间的风险比（HR）。我们发现，在五年随访期间，郊区和农村地区所有心血管事件的HR分别比城市地区高1.04倍（95%置信区间（CI）1.00 - 1.07）和1.15倍（95%CI 1.12 - 1.19）。与城市地区患者相比，郊区和农村地区患者发生充血性心力衰竭、中风和终末期肾病的可能性更大。此外，农村地区患者发生缺血性心脏病、失明和溃疡的可能性高于城市地区患者。我们的实证研究结果为台湾地区糖尿病相关并发症潜在的城乡差异提供了证据。
