Department of Clinical Sciences, Lund University, Malmö, Sweden.
Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
BMC Public Health. 2024 Oct 24;24(1):2948. doi: 10.1186/s12889-024-20435-7.
Hospitalization indicates the presence of severe disease and constitutes a leading cost in health care. We aimed to prospectively assess if prevalent diabetes mellitus contributes to excess all-cause and cause-specific hospital admissions and mortality at the population level.
We used a Swedish prospective population-based cohort, including 25,642 individuals of whom 4.2% had prevalent diabetes at baseline (mean age 61.2 ± 6.8 years, age range 44.8-73.4 years). We compared the number of hospitalizations and mortality classified according to the main chapters of the 10th revision of the International Classification of Diseases (ICD-10) during follow-up using nationwide inpatient registries, comparing individuals with and without prevalent diabetes, using multivariate adjusted negative binomial regression (incidence rate ratio, IRR) and Cox regression, respectively.
During a median follow-up of 19 years, 18,904 subjects were hospitalized at least once [median 3 (IQR 2-6)] and 6767 (26.4%) individuals died. Overall, subjects with diabetes were hospitalized (IRR 1.83, p < 0.001) more often, and had a higher incidence rate of hospital admissions due to endocrine diseases (IRR 14.6, p < 0.001), dermatological diseases (IRR 3.7, p < 0.001), injuries and poisoning (IRR 2.7, p < 0.001), infectious diseases (IRR 2.5, p < 0.001), psychiatric diseases (IRR 2.0, p < 0.001), but also cardiovascular, hematological, genitourinary, neurologic and respiratory diseases compared with non-diabetic individuals. No difference was observed for hospital admissions due to cancer or musculoskeletal disorders. All-cause mortality was higher (HR 1.77, p < 0.001) in individuals with diabetes, with disease-specific mortality being significant only for cardiovascular and endocrine disease-related death.
At the population level, prevalent diabetes increased the hospitalization burden longitudinally due to diseases of most of the ICD-10 main chapters, except for cancer and musculoskeletal disorders. These novel findings challenge the current view on the spectrum of prevalent diabetes-related conditions and may have implications for screening and treatment strategies in diabetes.
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住院表明病情严重，是医疗保健的主要费用之一。我们旨在前瞻性评估是否现患糖尿病会导致人群水平的全因和特定病因住院和死亡增加。
我们使用了一项瑞典前瞻性基于人群的队列研究，共纳入了 25642 名参与者，其中 4.2%的参与者在基线时患有现患糖尿病（平均年龄 61.2±6.8 岁，年龄范围 44.8-73.4 岁）。我们使用全国住院患者登记系统，根据《国际疾病分类》第 10 版（ICD-10）的主要章节对随访期间的住院次数和死亡率进行了比较，比较了有和没有现患糖尿病的个体，分别使用多变量调整的负二项回归（发病率比，IRR）和 Cox 回归。
在中位随访 19 年期间，18904 名受试者至少住院一次[中位数 3（IQR 2-6）]，6767 名（26.4%）受试者死亡。总体而言，患有糖尿病的患者住院（IRR 1.83，p<0.001）更频繁，因内分泌疾病（IRR 14.6，p<0.001）、皮肤病（IRR 3.7，p<0.001）、损伤和中毒（IRR 2.7，p<0.001）、传染病（IRR 2.5，p<0.001）、精神疾病（IRR 2.0，p<0.001）而住院的发生率更高，但与非糖尿病患者相比，心血管疾病、血液疾病、泌尿生殖系统疾病、神经系统疾病和呼吸系统疾病的住院率也更高。因癌症或肌肉骨骼疾病而住院的人数没有差异。患有糖尿病的患者全因死亡率更高（HR 1.77，p<0.001），特定病因死亡率仅与心血管和内分泌疾病相关的死亡有关。
在人群水平上，现患糖尿病会导致疾病负担增加，导致大多数 ICD-10 主要章节的疾病住院，除了癌症和肌肉骨骼疾病。这些新发现挑战了当前对现患糖尿病相关疾病谱的看法，可能对糖尿病的筛查和治疗策略产生影响。
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