Institute of Biomedical Sciences, Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Ciurlionio g. 21, 03101 Vilnius, Lithuania.
Laboratory of Cancer Epidemiology, National Cancer Institute, P. Baublio g. 3b, 08406 Vilnius, Lithuania.
Int J Environ Res Public Health. 2020 Sep 20;17(18):6870. doi: 10.3390/ijerph17186870.
This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death-from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34-1.37). Greatest mortality risk was in the age group of 40-49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60-1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82-25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32-2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin.
这项回顾性队列研究旨在分析立陶宛 2 型糖尿病（T2DM）患者的总体和特定原因死亡率风险。T2DM 的诊断和降血糖药物的信息来自国家健康保险基金数据库，死因则来自死亡证明。计算了性别、年龄和日历标准化死亡率比（SMR）。此外，2010 年至 2017 年期间，有 89512 名患者接受了随访，随访时间为 592321 人年。两性的总体死亡率风险均增加（总体 SMR = 1.35，95%置信区间 [CI] 1.34-1.37）。在诊断为糖尿病时年龄在 40-49 岁的人群中（SMR = 1.68，95%CI 1.60-1.76）和 50 岁前死亡的人群中（SMR = 22.04，95%CI 18.82-25.81），死亡率风险最高。仅接受胰岛素治疗的患者的 SMR 最高（2.43，95%CI 2.32-2.55）。随着糖尿病病程的延长，死亡率风险增加，在所有这些组中，女性的死亡率风险更高。最高的特定原因 SMR 是与感染相关的原因（SMR = 1.44），特别是败血症（SMR = 1.78）、循环系统疾病（SMR = 1.42），特别是缺血性心脏病（SMR = 1.46）和脑血管疾病（SMR = 1.38）以及消化系统疾病（SMR = 1.35）。女性的癌症死亡率风险升高（SMR = 1.13），但男性则没有（SMR = 0.93）。总之，T2DM 患者的死亡率风险过高，女性的死亡率风险高于男性，且年轻患者、更年轻时诊断为 T2DM 的患者、糖尿病病程更长的患者以及需要胰岛素治疗的患者，其死亡率风险更高。
