Lain Samantha J, Stevens Lindsay, Craig Maria E, Jenkins Alicia J, Bell Kirstine J, Pryke Alison, Donaghue Kim C, Nassar Natasha
Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
Pediatr Diabetes. 2024 Mar 29;2024:1844752. doi: 10.1155/2024/1844752. eCollection 2024.
Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. . The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was diagnosed with type 1 diabetes at age < 16 in New South Wales (NSW), Australia, from 1990 to 2010. The register was linked to National Death Index registrations to ascertain timing and cause of death up to 31/12/2022. Risk factors for mortality were assessed using multivariable Cox regression models and observed mortality rate compared to "expected" rates in the Australian general population using indirect-standardized mortality ratios (SMR), overall and by sex and age at diagnosis. Diabetes-related cause of death categories were identified.
Of 5,417 children diagnosed with type 1 diabetes, 157 subsequently died, with all-cause mortality of 1.37/1,000 person years. Increased mortality risk was associated with living in most disadvantaged areas (aHR 1.81 (1.05, 3.11)) but not living in a rural area. Overall SMR was 2.83 (95% CI 2.40, 3.33) with females having higher SMR than males (4.18 vs. 2.19). Most common causes of death recorded were acute diabetes complications (26%), including diabetes ketoacidosis, accident/misadventure (21%), and chronic diabetes complications (15%). Alcohol and/or drug use contributed to 17% of deaths.
Compared to the general population, higher risk of mortality in people with type 1 diabetes was associated with female sex and living in area of socioeconomic disadvantage. Education about minimizing risk-taking behaviors should be communicated to young adults with type 1 diabetes.
评估儿童期发病的1型糖尿病与普通人群相比的死亡风险。研究人群来自澳大利亚和新西兰儿科内分泌学组糖尿病登记处，于1990年至2010年在澳大利亚新南威尔士州（NSW）16岁之前被诊断为1型糖尿病。该登记处与国家死亡指数登记处相关联，以确定截至2022年12月31日的死亡时间和原因。使用多变量Cox回归模型评估死亡风险因素，并使用间接标准化死亡率（SMR）将观察到的死亡率与澳大利亚普通人群的“预期”死亡率进行比较，总体以及按诊断时的性别和年龄进行比较。确定了与糖尿病相关的死亡原因类别。
在5417名被诊断为1型糖尿病的儿童中，有157人随后死亡，全因死亡率为1.37/1000人年。死亡风险增加与生活在最贫困地区有关（校正后风险比1.81（1.05，3.11）），但与生活在农村地区无关。总体SMR为2.83（95%可信区间2.40，3.33），女性的SMR高于男性（4.18对2.19）。记录的最常见死亡原因是急性糖尿病并发症（26%），包括糖尿病酮症酸中毒、意外事故/不幸事件（21%）和慢性糖尿病并发症（15%）。酒精和/或药物使用导致17%的死亡。
与普通人群相比，1型糖尿病患者较高的死亡风险与女性性别以及生活在社会经济不利地区有关。应向患有1型糖尿病的年轻人宣传尽量减少冒险行为的教育。
