Zhang Hongmei, Rogers Kris, Sukkar Louisa, Jun Min, Kang Amy, Young Tamara, Campain Anna, Cass Alan, Chow Clara K, Comino Elizabeth, Foote Celine, Gallagher Martin, Knight John, Liu Bette, Lung Thomas, McNamara Martin, Peiris David, Pollock Carol, Sullivan David, Wong Germaine, Zoungas Sophia, Jardine Meg, Hockham Carinna
The George Institute for Global Health, UNSW, Sydney, NSW, Australia.
Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Clin Transl Endocrinol. 2020 Nov 10;22:100240. doi: 10.1016/j.jcte.2020.100240. eCollection 2020 Dec.
To use linked routinely-collected health data to estimate diabetes prevalence and incidence in an Australian cohort of adults aged ≥45 years, and examine risk factors associated with incident disease.
The EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45) Study is a linked data study that combines baseline questionnaire responses from the population-based (2006-2009, = 267,153) with multiple routinely-collected health databases up to December 2014. Among participants with ≥1 linked result for any laboratory test, diabetes status was determined from multiple data sources according to standard biochemical criteria, use of glucose-lowering medication or self-report, and the prevalence and incidence rate calculated. Independent risk factors of incident diabetes were examined using multivariable Cox regression.
Among 152,169 participants with ≥1 linked laboratory result in the EXTEND45 database (mean age 63.0 years; 54.9% female), diabetes prevalence was 10.8% (95% confidence interval [CI] 10.6%-10.9%). Incident disease in those without diabetes at baseline ( = 135,810; mean age 62.5 years; 56.1% female) was 10.0 per 1,000 person-years (95% CI 9.8-10.2). In all age groups, diabetes incidence was lower in women compared to men, an association that persisted in the fully adjusted analyses. Other independent risk factors of diabetes were older age, being born outside of Australia (with the highest rate of 19.2 per 1,000 person-years observed in people born in South and Central Asia), lower education status, lower annual household income, residence in a major city, family history of diabetes, personal history of cardiovascular disease or hypertension, higher body mass index, smoking and long sleeping hours.
Our study represents an efficient approach to assessing diabetes frequency and its risk factors in the community. The infrastructure provided by the EXTEND45 Study will be useful for diabetes surveillance and examining other important clinical and epidemiological questions.
利用常规收集的关联健康数据，估算澳大利亚45岁及以上成年人群队列中的糖尿病患病率和发病率，并研究与新发疾病相关的危险因素。
45岁及以上慢性疾病结局研究（EXTEND45）是一项关联数据研究，它将基于人群的基线问卷调查结果（2006 - 2009年，n = 267,153）与截至2014年12月的多个常规收集的健康数据库相结合。在任何实验室检查有≥1个关联结果的参与者中，根据标准生化标准、降糖药物使用情况或自我报告，从多个数据源确定糖尿病状态，并计算患病率和发病率。使用多变量Cox回归分析新发糖尿病的独立危险因素。
在EXTEND45数据库中，有≥1个关联实验室检查结果的152,169名参与者（平均年龄63.0岁；54.9%为女性）中，糖尿病患病率为10.8%（95%置信区间[CI] 10.6% - 10.9%）。基线时无糖尿病的参与者（n = 135,810；平均年龄62.5岁；56.1%为女性）的新发疾病发病率为每1000人年10.0例（95% CI 9.8 - 10.2）。在所有年龄组中，女性的糖尿病发病率低于男性，这种关联在完全调整分析中仍然存在。糖尿病的其他独立危险因素包括年龄较大、出生在澳大利亚境外（在南亚和中亚出生的人群中观察到的发病率最高，为每1000人年19.2例）、教育程度较低、家庭年收入较低、居住在大城市、糖尿病家族史、心血管疾病或高血压个人史、较高的体重指数、吸烟和睡眠时间长。
我们的研究代表了一种评估社区糖尿病发病率及其危险因素的有效方法。EXTEND45研究提供的基础设施将有助于糖尿病监测以及研究其他重要的临床和流行病学问题。
