Hiroshi Yokomichi1, Akiko Nagai2, Makoto Hirata3, Mie Mochizuki4, Reiji Kojima1, Zentaro Yamagata1. 1. Department of Health Sciences University of Yamanashi Chuo Japan. 2. Department of Public Policy Institute of Medical Science The University of Tokyo Tokyo Japan. 3. Genetic Medicine and Services National Cancer Center Hospital Tokyo Japan. 4. Department of Pediatrics University of Yamanashi Chuo Japan.
Abstract
Objective: This study aimed to compare cause-specific mortality rates in patients with type 2 diabetes with and without various vascular complications. Methods: In Japanese hospitals, we followed up 30 834 patients with a mean age of 64.4 (standard deviation [SD]: 11.1) years. Patients were followed up from 2003 to 2007 for a median of 7.5 (interquartile range: 6.1-9.7) years. We calculated cause-specific mortality rates (number of deaths/1000 person-years) and confounder-adjusted hazard ratios in patients with macrovascular disease and in those with diabetic nephropathy, neuropathy and retinopathy, allowing for overlap of complications. Results: All-cause mortality rate was highest (51.4) in the nephropathy group, followed by the macrovascular disease group (45.2), the neuropathy group (39.5), the retinopathy group (38.7) and the nonvascular complication group (18.1). In the nephropathy group, morality rates of ischaemic heart, cerebrovascular, and infectious diseases and cancer were also highest among the groups. However, the cancer mortality rate was similar among the vascular complication groups. Relative to the nonvascular complication group, covariate-adjusted hazard ratios for ischaemic heart and cerebrovascular disease mortality were triple to quadruple in the macro- and microvascular complication groups. All-cause mortality rates rose exponentially according to age. Conclusion: Highest risks of all-cause, cancer, and ischaemic heart, infectious, and cerebrovascular disease mortality were determined in Japanese patients with diabetic nephropathy. Although cancer is the primary cause of death in Japanese patients with diabetes, cancer mortality rates are similar among those with and without vascular complications.
Objective: This study aimed to compare cause-specific mortality rates in patients with type 2 diabetes with and without various vascular complications. Methods: In Japanese hospitals, we followed up 30 834 patients with a mean age of 64.4 (standard deviation [SD]: 11.1) years. Patients were followed up from 2003 to 2007 for a median of 7.5 (interquartile range: 6.1-9.7) years. We calculated cause-specific mortality rates (number of deaths/1000 person-years) and confounder-adjusted hazard ratios in patients with macrovascular disease and in those with diabetic nephropathy, neuropathy and retinopathy, allowing for overlap of complications. Results: All-cause mortality rate was highest (51.4) in the nephropathy group, followed by the macrovascular disease group (45.2), the neuropathy group (39.5), the retinopathy group (38.7) and the nonvascular complication group (18.1). In the nephropathy group, morality rates of ischaemic heart, cerebrovascular, and infectious diseases and cancer were also highest among the groups. However, the cancer mortality rate was similar among the vascular complication groups. Relative to the nonvascular complication group, covariate-adjusted hazard ratios for ischaemic heart and cerebrovascular diseasemortality were triple to quadruple in the macro- and microvascular complication groups. All-cause mortality rates rose exponentially according to age. Conclusion: Highest risks of all-cause, cancer, and ischaemic heart, infectious, and cerebrovascular diseasemortality were determined in Japanese patients with diabetic nephropathy. Although cancer is the primary cause of death in Japanese patients with diabetes, cancer mortality rates are similar among those with and without vascular complications.
Authors: Andrew J Karter; Assiamira Ferrara; Jennifer Y Liu; Howard H Moffet; Lynn M Ackerson; Joe V Selby Journal: JAMA Date: 2002-05-15 Impact factor: 56.272
Authors: John H Kempen; Benita J O'Colmain; M Cristina Leske; Steven M Haffner; Ronald Klein; Scot E Moss; Hugh R Taylor; Richard F Hamman Journal: Arch Ophthalmol Date: 2004-04
Authors: Sarah Rosner Preis; Shih-Jen Hwang; Sean Coady; Michael J Pencina; Ralph B D'Agostino; Peter J Savage; Daniel Levy; Caroline S Fox Journal: Circulation Date: 2009-03-23 Impact factor: 29.690
Authors: Alexander Thompson; Emanuele Di Angelantonio; Pei Gao; Nadeem Sarwar; Sreenivasa Rao Kondapally Seshasai; Stephen Kaptoge; Peter H Whincup; Kenneth J Mukamal; Richard F Gillum; Ingar Holme; Inger Njølstad; Astrid Fletcher; Peter Nilsson; Sarah Lewington; Rory Collins; Vilmundur Gudnason; Simon G Thompson; Naveed Sattar; Elizabeth Selvin; Frank B Hu; John Danesh Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245