Nicholas Weight, Andrew Cole, Muhammad Rashid, Kamlesh Khunti, Shivani Misra, Evangelos Kontopantelis, Thomas A. Shepherd, Martin K. Rutter, Mamas A. Mamas
{"title":"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","authors":"Nicholas Weight, Andrew Cole, Muhammad Rashid, Kamlesh Khunti, Shivani Misra, Evangelos Kontopantelis, Thomas A. Shepherd, Martin K. Rutter, Mamas A. Mamas","doi":"10.1111/dme.70111","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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), <i>p</i> < 0.001). Risk of 1-year (aHR: 1.05 (1.01–1.10), <i>p</i> < 0.001), 5-year (aHR: 1.14 (1.11–1.17), <i>p</i> < 0.001) and overall mortality (aHR: 1.14 (1.12–1.17), <i>p</i> < 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), <i>p</i> < 0.001), 5 years (aHR: 1.18 (1.16–1.20), <i>p</i> < 0.001) and overall (aHR: 1.22 (1.20–1.23), <i>p</i> < 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%).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 11","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70111","citationCount":"0","resultStr":"{\"title\":\"The impact of socio-economic deprivation on the long-term survival of people with diabetes and acute myocardial infarction: A nationwide cohort study\",\"authors\":\"Nicholas Weight, Andrew Cole, Muhammad Rashid, Kamlesh Khunti, Shivani Misra, Evangelos Kontopantelis, Thomas A. Shepherd, Martin K. Rutter, Mamas A. Mamas\",\"doi\":\"10.1111/dme.70111\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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), <i>p</i> < 0.001). Risk of 1-year (aHR: 1.05 (1.01–1.10), <i>p</i> < 0.001), 5-year (aHR: 1.14 (1.11–1.17), <i>p</i> < 0.001) and overall mortality (aHR: 1.14 (1.12–1.17), <i>p</i> < 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), <i>p</i> < 0.001), 5 years (aHR: 1.18 (1.16–1.20), <i>p</i> < 0.001) and overall (aHR: 1.22 (1.20–1.23), <i>p</i> < 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%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>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. 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The impact of socio-economic deprivation on the long-term survival of people with diabetes and acute myocardial infarction: A nationwide cohort study
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.
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.”
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