Excess Mortality among Persons with Type 2 Diabetes

Tancredi, M.; Rosengren, Annika; Svensson, Ann‐Marie; Kosiborod, Mikhail; Pivodic, Aldina; Guðbjörnsdóttir, Soffia; Wedel, Hans; Clements, Mark A.; Dahlqvist, Sofia; Lind, Marcus

doi:10.1056/nejmoa1504347

Cited by 853 publications

(661 citation statements)

References 27 publications

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“…quadruples cardiovascular risk, compared with the general population (6,7), but also leads to an increased risk of cancer, as shown by some cohort studies (5,8).…”

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confidence: 88%

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

et al. 2016

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OBJECTIVEDiabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODSWe used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTSWe included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONSDiabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.Diabetes constitutes a worldwide public health problem (1) that affected 382 million people (8.3% of the world's population) in 2013 (2). Recent projections suggest that this prevalence is likely to increase in the next 20 years, affecting 592 million people (10.1%) in 2035. In Spain, diabetes affects 13.8% of individuals older than 18 years and is more prevalent in men than in women (3,4).The average life expectancy of a 50-year-old individual with diabetes is 6 years shorter than it would be without the disease (5). Diabetes not only doubles or

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“…quadruples cardiovascular risk, compared with the general population (6,7), but also leads to an increased risk of cancer, as shown by some cohort studies (5,8).…”

mentioning

confidence: 88%

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

et al. 2016

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“…Both ALD and NAFLD appear to be risk factors for T2DM, and T2DM is a risk factor for more severe liver disease in people with ALD or NAFLD (1)(2)(3)(4)(5)(6). The increased risk of CVD, cancer and mortality among people with type 2 diabetes, compared to people without diabetes, is well known (7)(8)(9). There is evidence of an association between NAFLD and CVD among people with and without diabetes although it is recognised that further information is needed in terms of describing the natural history of NAFLD with regard to both its hepatic and extra-hepatic complications(10; 11), On the basis of existing evidence it appears that more advanced liver disease is associated with higher risk of complications (11; 12).…”

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confidence: 99%

Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission

et al. 2017

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OBJECTIVE To describe associations between alcoholic fatty liver disease (ALD) or non-alcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with T2DM. RESEARCH DESIGN AND METHODSWe performed a retrospective cohort study using linked population-based routine data from the diabetes register, hospital, cancer and death records for people aged 40-89 years, diagnosed with T2DM in Scotland 2004-2013 who had one or more hospital admission records. Liver disease and outcomes were identified using International Classification of Diseases codes.We estimated hazard ratios from Cox proportional hazards models, adjusted for key risk factors (aHRs). RESULTS

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“…In a recent large study of more than 400,000 type 2 diabetic patients and over 2 million controls in Sweden, Tancredi et al also adopted a matching study design with five controls to one case of type 2 diabetes [24]. They found that the associations of type 2 diabetes with death from any cause and death from cardiovascular causes decreased with increasing age.…”

Section: Discussionmentioning

confidence: 99%

Life years lost associated with diabetes: An individually matched cohort study using the U.S. National Health Interview Survey data

Wang

Liu

2016

Diabetes Research and Clinical Practice

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Aim: Previous estimates of life-years lost to diabetes are highly inconsistent. This study provided the updated estimates of life-years lost to diabetes in the United States.Methods: Each of a nationally representative sample of 21,829 adults with diabetes in the U.S. National Health Interview Survey 1997─2009 was individually matched to one without diabetes by age, sex, race, survey year, BMI, smoking status, pre-existing cardiovascular disease and pre-existing cancer. All-cause mortality from original surveys to 31 December 2011 and median survival ages were estimated for those with diabetes and their matched controls.Results: Overall median survival age for adults with diabetes was 10.5 years shorter than that for matched controls without diabetes. Estimated life-years lost associated with diabetes decreased with increasing age at diagnosis from 20.0 years for those diagnosed before age 20 years to no difference for those diagnosed after 80 years. Hazard ratios for mortality decreased from 3.03 (95% CI: 2.41, 3.80) for those with diabetes diagnosed before 20 years to 1.04 (95% CI: 0.78, 1.39) for those diagnosed after 80 years. The estimate of life-years lost associated with diabetes was much higher among those with pre-existing cardiovascular disease (20.3 years) than among those without cardiovascular disease (8.5 years). Conclusions:The effect of diabetes on survival depends on age at first diagnosis of diabetes and the presence of pre-existing diseases. The life-years lost are higher for those with diabetes diagnosed at younger ages. This study provided the updated estimates of life-years lost associated with diabetes in the United States.

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Excess Mortality among Persons with Type 2 Diabetes

Cited by 853 publications

References 27 publications

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission

Life years lost associated with diabetes: An individually matched cohort study using the U.S. National Health Interview Survey data

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