Diabetes and the risk of infection-related mortality in the US

被引:185
作者
Bertoni, AG
Saydah, S
Brancati, FL
机构
[1] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA
关键词
D O I
10.2337/diacare.24.6.1044
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To determine whether diabetes predicts infection-related mortality and to clarify the extent to which this relationship is mediated by comorbid conditions that may themselves increase risk of infection. RESEARCH DESIGN AND METHODS - We performed a retrospective cohort study using the Second National Health and Nutrition Examination Survey Mortality Study of 9,208 adults aged 30-74 years in 1976-1980. We defined demographic variables, diabetes, cardiovascular disease (CVD), and smoking by self-report; BMI, blood pressure, and serum cholesterol from baseline examination; and cause-specific mortality from death certificates. RESULTS - Over 12-16 years of follow-up, 36 infection-related deaths occurred among 533 adults with diabetes vs. 265 deaths in 8,675 adults without diabetes (4.7 vs. 1.5 per 1,000 person-years, P < 0.001). Diabetes (RR 2.0, 95% CI 1.2-3.2) and congestive heart failure (2.8, 1.6-5.1) were independent predictors of infection related mortality after simultaneous adjustment for age, sex, race, poverty status, smoking, BMI, and hypertension. After subdividing infection-related deaths into those with (n = 145) and without (n = 156) concurrent cardiovascular diagnoses at the time of death, diabetic adults were at risk for infection-related death with CVD (3.0, 1.8-5.0) but nor without CVD (1.0, 0.5-2.2). CONCLUSIONS - These nationally representative data suggest that diabetic adults are at greater risk for infection related mortality, and the excess risk may be mediated by CVD.
引用
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页码:1044 / 1049
页数:6
相关论文
共 33 条
[1]  
ANDREWS BE, 1987, Q J MED, V62, P195
[2]   QUALITY OF DEATH CERTIFICATES IN VALENCIA, SPAIN [J].
BENAVIDES, FG ;
BOLUMAR, F ;
PERIS, R .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1989, 79 (10) :1352-1354
[3]  
Boyko EJ, 1995, Diabetes in America, P485
[4]   SELF-REPORT AND MEDICAL RECORD REPORT AGREEMENT OF SELECTED MEDICAL CONDITIONS IN THE ELDERLY [J].
BUSH, TL ;
MILLER, SR ;
GOLDEN, AL ;
HALE, WE .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1989, 79 (11) :1554-1556
[5]   Prognosis and outcomes of patients with community-acquired pneumonia - A meta-analysis [J].
Fine, MJ ;
Smith, MA ;
Carson, CA ;
Mutha, SS ;
Sankey, SS ;
Weissfeld, LA ;
Kapoor, WN .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (02) :134-141
[6]   A prediction rule to identify low-risk patients with community-acquired pneumonia [J].
Fine, MJ ;
Auble, TE ;
Yealy, DM ;
Hanusa, BH ;
Weissfeld, LA ;
Singer, DE ;
Coley, CM ;
Marrie, TJ ;
Kapoor, WN .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (04) :243-250
[7]   Mortality in adults with and without diabetes in a national cohort of the US population, 1971-1993 [J].
Gu, K ;
Cowie, CC ;
Harris, MI .
DIABETES CARE, 1998, 21 (07) :1138-1145
[8]   PREVALENCE OF DIABETES AND IMPAIRED GLUCOSE-TOLERANCE AND PLASMA-GLUCOSE LEVELS IN UNITED-STATES POPULATION AGED 20-74 YR [J].
HARRIS, MI ;
HADDEN, WC ;
KNOWLER, WC ;
BENNETT, PH .
DIABETES, 1987, 36 (04) :523-534
[9]   Primary care: Infections in patients with diabetes mellitus [J].
Joshi, N ;
Caputo, GM ;
Weitekamp, MR ;
Karchmer, AW .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (25) :1906-1912
[10]  
Kahn HA., 1989, STAT METHODS EPIDEMI