Chen Vincent L, Tedesco Nicholas R, Hu Jingyi, Jasty Venkata S J, Perumalswami Ponni V
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor.
Am J Med. 2025 May;138(5):809-818.e10. doi: 10.1016/j.amjmed.2025.01.007. Epub 2025 Jan 20.
Social determinants of health are key factors driving disease progression. In type 2 diabetes there is limited literature on how distal or intermediate factors (eg, those at the neighborhood level) influence cause-specific mortality or liver disease outcomes.
This was a single-center retrospective study of patients with type 2 diabetes seen at an integrated healthcare system in the United States. The primary outcomes were overall mortality; death due to cardiovascular disease, cancer, or liver disease; or hepatic decompensation. The primary predictors were neighborhood-level (intermediate) factors measuring neighborhood poverty (Area Deprivation Index [ADI], affluence score, disadvantage score) and rurality (Rural-Urban Commuting Area scores). Associations were modeled using Cox proportional hazards or Fine-Grey competing risk models.
28,424 participants were included. Higher neighborhood poverty associated with increased overall mortality, with hazard ratio (HR) 1.11 (95% confidence interval 1.10-1.12, P < .001) per 10 points of ADI and HR 1.32 (95% CI 1.26-1.37, P < .001) for 10 points of disadvantage. Conversely, higher neighborhood affluence associated with lower overall mortality with HR 0.87 (95% CI 0.86-0.89, P < .001) per 10 points of affluence. Living in a rural region associated with increased overall mortality: HR 1.08 (95% CI 1.01-1.15, P = .031). Associations were consistent across cause-specific mortality, though effect sizes were larger for liver-related mortality than for other causes. Living in a more rural neighborhood was associated with increased risk of hepatic decompensation.
Intermediate neighborhood-level socioeconomic status was associated with overall and cause-specific mortality in type 2 diabetes, with larger effects on liver-related mortality than other causes.
健康的社会决定因素是推动疾病进展的关键因素。关于2型糖尿病中远端或中间因素（如社区层面的因素）如何影响特定病因死亡率或肝病结局的文献有限。
这是一项对美国一家综合医疗系统中2型糖尿病患者的单中心回顾性研究。主要结局为全因死亡率；心血管疾病、癌症或肝病导致的死亡；或肝失代偿。主要预测因素为社区层面（中间）因素，测量社区贫困程度（地区贫困指数[ADI]、富裕程度评分、劣势评分）和农村程度（城乡通勤区评分）。使用Cox比例风险模型或Fine-Grey竞争风险模型对关联进行建模。
纳入28424名参与者。社区贫困程度越高，全因死亡率越高，每10分ADI的风险比（HR）为1.11（95%置信区间1.10-1.12，P<.001），每10分劣势的HR为1.32（95%CI 1.26-1.37，P<.001）。相反，社区富裕程度越高，全因死亡率越低，每10分富裕程度的HR为0.87（95%CI 0.86-0.89，P<.001）。生活在农村地区与全因死亡率增加相关：HR为1.08（95%CI 1.01-1.15，P=.031）。特定病因死亡率的关联一致，尽管与肝脏相关死亡率的效应大小大于其他病因。生活在农村程度更高的社区与肝失代偿风险增加相关。
社区层面的中间社会经济地位与2型糖尿病的全因和特定病因死亡率相关，对肝脏相关死亡率的影响大于其他病因。
