The impact of socio-economic deprivation on the long-term survival of people with diabetes and acute myocardial infarction: A nationwide cohort study

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-07-28 DOI:10.1111/dme.70111

Nicholas Weight, Andrew Cole, Muhammad Rashid, Kamlesh Khunti, Shivani Misra, Evangelos Kontopantelis, Thomas A. Shepherd, Martin K. Rutter, Mamas A. Mamas

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Abstract

Background

People from areas of socio-economic deprivation have poorer outcomes following acute myocardial infarction (AMI). How deprivation influences the survival of people with diabetes mellitus (DM) post-AMI is not well described.

Methods

Using the Myocardial Ischaemia National Audit Project (MINAP) registry, with Office for National Statistics (ONS) mortality recording, 729,722 patients from England and Wales between 2005 and 2019 were included, 152,867 with DM and followed up to 31 July 2021. Patients were stratified into quintiles using the Index of Multiple Deprivation (IMD) score (Q1—most-deprived, Q5—least deprived), Cox regression models were fitted and adjusted mortality risk estimates were compared by IMD quintile and DM status.

Results

Thirty-day mortality risk between Q1 (most deprived) and Q5 (least deprived) was similar for patients with DM, but in patients without DM, risk was higher in the most deprived group (aHR: 1.05 (1.01–1.09), p < 0.001). Risk of 1-year (aHR: 1.05 (1.01–1.10), p < 0.001), 5-year (aHR: 1.14 (1.11–1.17), p < 0.001) and overall mortality (aHR: 1.14 (1.12–1.17), p < 0.001) was higher in Q1 compared to Q5 for patients with DM, but this increase was smaller than in patients without DM at 1 year (aHR: 1.12 (1.09–1.14), p < 0.001), 5 years (aHR: 1.18 (1.16–1.20), p < 0.001) and overall (aHR: 1.22 (1.20–1.23), p < 0.001). Adjusted 1-year mortality was higher in patients with DM than those without DM regardless of IMD quintile (e.g. DM vs. non-DM: Q1: 18.8% vs. 16.1%, Q5: 17.8% vs. 14.6%).

Conclusion

Patients with DM from socio-economically deprived regions have a higher risk of mortality at 1 year, 5 years and overall, compared to least deprived patients with DM following AMI. However, the inequality gap was larger in the non-diabetic population, suggesting that current approaches to management in people with DM may mitigate some of the effect of deprivation on outcomes.

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社会经济剥夺对糖尿病和急性心肌梗死患者长期生存的影响：一项全国性队列研究

背景：来自社会经济贫困地区的人急性心肌梗死（AMI）后的预后较差。剥夺如何影响ami后糖尿病患者（DM）的生存尚不清楚。方法：使用心肌缺血国家审计项目（MINAP）注册表，并记录国家统计局（ONS）的死亡率，纳入2005年至2019年期间来自英格兰和威尔士的729,722例患者，其中152,867例为糖尿病，随访至2021年7月31日。使用多重剥夺指数（IMD）评分（q1最剥夺，q5最剥夺）将患者分层，拟合Cox回归模型，并根据IMD五分位数和糖尿病状态比较调整后的死亡风险估计值。结果：DM患者Q1（最贫困）和Q5（最贫困）之间的30天死亡风险相似，但在非DM患者中，最贫困组的风险更高(aHR: 1.05 (1.01-1.09)， p结论：来自社会经济贫困地区的DM患者在1年、5年和总体上的死亡风险高于AMI后DM患者。然而，非糖尿病人群的不平等差距更大，这表明目前对糖尿病患者的管理方法可能会减轻剥夺对结果的一些影响。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”