Diabetes and all-cause mortality among middle-aged and older adults in China, England, Mexico, rural South Africa, and the USA: a population-based study of longitudinal aging cohorts.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
David Flood, Yuan S Zhang, Emma Nichols, Chihua Li, Paola Zaninotto, Kenneth M Langa, Jinkook Lee, Jennifer Manne-Goehler
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Abstract

Objective: There is a need for comparable worldwide data on the impact of diabetes on mortality. This study assessed diabetes and all-cause mortality among middle-aged and older adults in five countries.

Research design and methods: We analyzed adults aged 51 years or older followed between 2010 and 2020 from population-based cohorts from China, England, Mexico, rural South Africa, and the USA. The cohorts are part of an international network of longitudinal aging studies with similar sampling designs, eligibility, and assessment methods. Diabetes was defined by self-report or an elevated diabetes blood-based biomarker meeting the clinical criteria for diabetes. All-cause mortality was assessed through linkages or informant interviews. We used Poisson regression models to estimate mortality rate ratios and mortality rate differences, comparing people with diabetes to those without diabetes. Models were adjusted for age, gender, education, smoking status, body mass index, economic status, and, in South Africa, HIV status.

Results: We included 29 397 individuals, of whom 4916 (16.7%) died during the study period. The median follow-up time ranged from 4.6 years in South Africa to 8.3 years in China. The adjusted all-cause mortality rate ratios for people with diabetes versus those without diabetes ranged from 1.53 (95% CI: 1.39 to 1.68) in the USA to 2.02 (95% CI: 1.34 to 3.06) in Mexico. The adjusted mortality rate differences (per 1000 person-years) for people with diabetes vers those without diabetes ranged from 11.9 (95% CI: 4.8 to 18.9) in England to 24.6 (95% CI: 12.2 to 37.0) in South Africa.

Conclusions: Diabetes was associated with increased all-cause mortality in population-based cohorts in China, England, Mexico, rural South Africa, and the USA. Limitations included differences in diabetes biomarkers and selection criteria across cohorts. The results highlight the urgent need to implement clinical and public health interventions worldwide to reduce excess diabetes mortality.

中国、英国、墨西哥、南非农村和美国中老年人群的糖尿病和全因死亡率:一项基于人群的纵向老龄化队列研究
目的:需要关于糖尿病对死亡率影响的可比较的全球数据。这项研究评估了五个国家中老年人的糖尿病和全因死亡率。研究设计和方法:我们分析了2010年至2020年间来自中国、英国、墨西哥、南非农村和美国的51岁及以上的成年人。该队列是纵向老龄化研究国际网络的一部分,具有相似的抽样设计,资格和评估方法。糖尿病通过自我报告或符合糖尿病临床标准的糖尿病血液生物标志物升高来定义。全因死亡率通过联系或信息者访谈进行评估。我们使用泊松回归模型来估计死亡率比和死亡率差异,比较糖尿病患者和非糖尿病患者。模型根据年龄、性别、教育程度、吸烟状况、体重指数、经济状况以及南非的艾滋病毒状况进行了调整。结果:纳入29397人,其中4916人(16.7%)在研究期间死亡。中位随访时间从南非的4.6年到中国的8.3年不等。调整后的糖尿病患者与非糖尿病患者的全因死亡率比从美国的1.53 (95% CI: 1.39 - 1.68)到墨西哥的2.02 (95% CI: 1.34 - 3.06)不等。糖尿病患者与非糖尿病患者的调整死亡率差异(每1000人年)从英格兰的11.9 (95% CI: 4.8 - 18.9)到南非的24.6 (95% CI: 12.2 - 37.0)不等。结论:在中国、英国、墨西哥、南非农村和美国的人群队列中,糖尿病与全因死亡率增加有关。局限性包括糖尿病生物标志物和队列选择标准的差异。研究结果强调,迫切需要在世界范围内实施临床和公共卫生干预措施,以降低糖尿病的死亡率。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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