2型糖尿病老年患者中儿童与其教育程度与糖尿病相关并发症及死亡率的关联：一项全国性队列研究
The Association of Children and Their Educational Attainment With Diabetes-related Complications and Mortality Among Older Adults With Type 2 Diabetes: A Nationwide Cohort Study.
作者信息
Larsen Emma Neble, Brünnich Sloth Mathilde Marie, Nielsen Jannie, Osler Merete, Jørgensen Terese Sara Høj
机构信息
Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
出版信息
Can J Diabetes. 2023 Dec;47(8):649-657.e6. doi: 10.1016/j.jcjd.2023.07.004. Epub 2023 Jul 17.
OBJECTIVE
Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D) and are associated with a lower risk of diabetes-related complications and death. We investigated the associations of having children and their educational level with diabetes-related complications and death among older adults with T2D.
METHODS
We included 74,588 adults who were at least 65 years of age at the time of T2D diagnosis over the period from 2000 to 2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children's highest educational level (low/medium/high [reference]). Multistate models were performed with 3 states: T2D diagnosis, diabetes-related complications, and death. All models were stratified by other chronic diseases at baseline (yes/no).
RESULTS
During follow-up (mean, 5.5 years), 14.6% of the adults developed a complication and 24.8% died with or without complications. Not having children was associated with a higher hazard of death without complications among adults without (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.17 to 1.33) and with (HR, 1.10; 95% CI, 1.02 to 1.18) other chronic diseases and after complications among adults without other chronic diseases (HR, 1.25; 95% CI, 1.12 to 1.38). Having children with a lower educational level was associated with a higher hazard of complications (HR, 1.14; 95% CI, 1.05 to 1.24; HR, 1.11; 95% CI, 1.05 to 1.17), death without complications (HR, 1.26; 95% CI, 1.17 to 1.36; HR, 1.07; 95% CI, 1.02 to 1.14), and after complications (HR, 1.22; 95% CI, 1.07 to 1.39) among adults without other chronic diseases.
CONCLUSIONS
Among adults without other chronic diseases, having no children or having children with lower educational levels was associated with a higher hazard of death. Among these adults, having children with lower educational levels was also associated with a higher hazard of diabetes-related complications.
目的
社会经济资源和家庭支持已被证明可提高2型糖尿病（T2D）患者的治疗依从性，并与较低的糖尿病相关并发症和死亡风险相关。我们调查了T2D老年患者生育子女情况及其教育水平与糖尿病相关并发症和死亡之间的关联。
方法
我们纳入了2000年至2018年期间在丹麦确诊T2D时年龄至少为65岁的74588名成年人，并根据其生育子女情况（是[参照组]/否）及其子女的最高教育水平（低/中/高[参照组]）进行分组。采用多状态模型，分为3种状态：T2D诊断、糖尿病相关并发症和死亡。所有模型均按基线时是否患有其他慢性病（是/否）进行分层。
结果
在随访期间（平均5.5年），14.6%的成年人出现了并发症，24.8%的成年人无论有无并发症均死亡。在无其他慢性病的成年人中，无子女与无并发症死亡风险较高相关（风险比[HR]，1.25；95%置信区间[CI]，1.17至1.33），在有其他慢性病的成年人中也相关（HR, 1.10；95% CI，1.02至1.18），在无其他慢性病的成年人出现并发症后同样相关（HR, 1.25；9% CI，1.12至1.）。在无其他慢性病的成年人中，子女教育水平较低与并发症风险较高相关（HR, 1.14；95% CI，1.05至1.24；HR, 1.11；95% CI，1.05至1.17）、无并发症死亡风险较高相关（HR, 1.26；95% CI，1.17至1.36；HR, 1.07；95% CI，1.02至1.14），以及出现并发症后死亡风险较高相关（HR, 1.22；95% CI，1.07至1.39）。
结论
在无其他慢性病的成年人中，无子女或子女教育水平较低与较高的死亡风险相关。在这些成年人中，子女教育水平较低还与较高的糖尿病相关并发症风险相关。
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