Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada.
ICES, Toronto, ON, Canada.
BMC Endocr Disord. 2023 Jun 2;23(1):127. doi: 10.1186/s12902-023-01362-x.
Individuals with Type 2 Diabetes are likely to experience multimorbidity and accumulate multiple chronic conditions over their life. We aimed to identify causes of death and chronic conditions at the time of death in a population-based cohort, and to analyze variations in the presence of diabetes at the time of death overall and across income and immigrant status.
We conducted a retrospective cohort study of 2,199,801 adult deaths from 1992 to 2017 in Ontario, Canada. We calculated the proportion of decedents with chronic conditions at time of death and causes of death. The risk of diabetes at the time of death was modeled across sociodemographic variables with a log binomial regression adjusting for sex, age, immigrant status, area-level income. comorbiditiesand time.
The leading causes of death in the cohort were cardiovascular and cancer. Decedents with diabetes had a higher prevalence of most chronic conditions than decedents without diabetes, including hypertension, osteo and other arthritis, chronic coronary syndrome, mood disorder, and congestive heart failure. The risk of diabetes at the time of death was 19% higher in immigrants (95%CI 1.18-1.20) and 15% higher in refugees (95%CI 1.12-1.18) compared to long-term residents, and 19% higher in the lowest income quintile (95%CI 1.18-1.20) relative to the highest income quintile, after adjusting for other covariates.
Individuals with diabetes have a greater multimorbidity burden at the time of death, underscoring the importance of multiple chronic disease management among those living with diabetes and further considerations of the social determinants of health.
2 型糖尿病患者一生中可能会同时患有多种疾病，并积累多种慢性疾病。我们旨在确定基于人群的队列中死亡时的死因和慢性疾病，并分析整体和按收入和移民身份划分的死亡时糖尿病存在情况的变化。
我们对 1992 年至 2017 年期间加拿大安大略省的 2,199,801 例成人死亡进行了回顾性队列研究。我们计算了死亡时患有慢性疾病的死者比例和死因。使用对数二项式回归模型，根据社会人口统计学变量（性别、年龄、移民身份、地区收入水平、合并症和时间）调整了死亡时糖尿病的风险。
队列中的主要死因是心血管疾病和癌症。患有糖尿病的死者比没有糖尿病的死者更普遍患有大多数慢性疾病，包括高血压、骨关节炎和其他关节炎、慢性冠状动脉综合征、情绪障碍和充血性心力衰竭。与长期居民相比，移民（95%CI 1.18-1.20）和难民（95%CI 1.12-1.18）的死亡时患糖尿病的风险分别高 19%和 15%，而与最高收入五分位数（95%CI 1.18-1.20）相比，最低收入五分位数的风险高 19%，调整了其他协变量后。
死亡时患有糖尿病的个体的多态性负担更大，这突显了在患有糖尿病的个体中进行多种慢性疾病管理的重要性，并进一步考虑了健康的社会决定因素。
