Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China.
Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
Sci Rep. 2024 May 7;14(1):10458. doi: 10.1038/s41598-024-58502-z.
To evaluate the effect of diabetic retinopathy (DR) status or severity on all-cause and cause-specific mortality among diabetic older adults in the United States using the most recent National Health and Nutrition Examination Survey (NHANES) follow-up mortality data. The severity of DR was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale. Multiple covariate-adjusted Cox proportional hazards regression models, Fine and Gray competing risk regression models, and propensity score matching (PSM) methods were used to assess the risk of all-cause and cause-specific mortality in individuals with diabetes. All analyses adopted the weighted data and complex stratified design approach proposed by the NHANES guidelines. Time to death was calculated based on the time between baseline and date of death or December 31, 2019, whichever came first. Ultimately 1077 participants, representing 3,025,316 US non-hospitalized individuals with diabetes, were included in the final analysis. After a median follow-up of 12.24 years (IQR, 11.16-13.49), 379 participants were considered deceased from all-causes, with 43.90% suffering from DR, including mild DR (41.50%), moderate to severe DR (46.77%), and proliferative DR (PDR) (67.21%). DR was associated with increased all-cause, cardiovascular disease (CVD) and diabetes mellitus (DM)-specific mortality, which remained consistent after propensity score matching (PSM). Results of DR grading assessment suggested that the presence of mild, moderate to severe NPDR was significantly associated with increased risk of all-cause and CVD-specific mortality, while the presence and severity of any DR was associated with increased DM-specific mortality, with a positive trend. The presence of DR in elderly individuals with diabetes is significantly associated with the elevated all-cause and CVD mortality. The grading or severity of DR may reflect the severity of cardiovascular disease status and overall mortality risk in patients with diabetes.
为了评估美国糖尿病老年患者的糖尿病视网膜病变（DR）状态或严重程度对全因和特定原因死亡率的影响，我们使用了最新的全国健康和营养调查（NHANES）随访死亡率数据。DR 的严重程度根据早期治疗糖尿病视网膜病变研究（ETDRS）分级量表进行分级。使用多变量调整的 Cox 比例风险回归模型、Fine 和 Gray 竞争风险回归模型和倾向评分匹配（PSM）方法评估了糖尿病患者的全因和特定原因死亡率风险。所有分析均采用了 NHANES 指南提出的加权数据和复杂分层设计方法。死亡时间根据从基线到死亡日期或 2019 年 12 月 31 日之间的时间（以先到者为准）计算。最终有 1077 名参与者，代表 3025316 名美国非住院糖尿病患者，纳入最终分析。中位随访 12.24 年后（IQR，11.16-13.49），379 名参与者被认为死于全因，其中 43.90%患有 DR，包括轻度 DR（41.50%）、中度至重度 DR（46.77%）和增生性 DR（PDR）（67.21%）。DR 与全因、心血管疾病（CVD）和糖尿病（DM）特异性死亡率增加相关，经倾向评分匹配（PSM）后仍保持一致。DR 分级评估结果表明，轻度、中度至重度 NPDR 的存在与全因和 CVD 特异性死亡率增加显著相关，而任何 DR 的存在和严重程度与 DM 特异性死亡率增加相关，呈正相关趋势。老年糖尿病患者存在 DR 与全因和 CVD 死亡率升高显著相关。DR 的存在或严重程度可能反映了糖尿病患者心血管疾病状态和总体死亡率风险的严重程度。
