Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

被引：37

作者：

Anjana, Ranjit Mohan ^{[1
,2
]}

Mohan, Viswanathan ^{[1
,2
]}

Rangarajan, Sumathy ^{[3
]}

Gerstein, Hertzel C. ^{[3
]}

Venkatesan, Ulagamadesan ^{[1
,2
]}

Sheridan, Patrick ^{[3
]}

Dagenais, Gilles R. ^{[4
]}

Lear, Scott A. ^{[5
,6
,7
]}

Teo, Koon ^{[3
]}

Karsidag, Kubilay ^{[8
]}

Alhabib, Khalid F. ^{[9
]}

Yusoff, Khalid ^{[10
,11
]}

Ismail, Noorhassim ^{[12
]}

Mony, Prem K. ^{[13
]}

Lopez-Jaramillo, Patricio ^{[14
]}

Chifamba, Jephat ^{[15
]}

Palileo-Villanueva, Lia M. ^{[16
]}

Iqbal, Romaina ^{[17
]}

Yusufali, Afzalhussein ^{[18
]}

Kruger, Iolanthe M. ^{[19
]}

Rosengren, Annika ^{[20
,21
]}

Bahonar, Ahmad ^{[22
]}

Zatonska, Katarzyna ^{[23
]}

Yeates, Karen ^{[24
]}

Gupta, Rajeev ^{[25
]}

Li, Wei ^{[26
]}

Hu, Lihua ^{[27
]}

Rahman, M. Omar ^{[28
]}

Lakshmi, P. V. M. ^{[29
]}

Iype, Thomas ^{[30
]}

Avezum, Alvaro ^{[31
,32
]}

Diaz, Rafael ^{[33
]}

Lanas, Fernando ^{[34
]}

Yusuf, Salim ^{[3
]}

机构：

[1] Madras Diabet Res Fdn, Chennai, Tamil Nadu, India

[2] Dr Mohans Diabet Special Ctr, Chennai, Tamil Nadu, India

[3] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada

[4] Quebec Univ Laval, Inst Univ Cardiol & Pneum, Quebec City, PQ, Canada

[5] Simon Fraser Univ, Dept Biomed Physiol & Kinesiol, Burnaby, BC, Canada

[6] Simon Fraser Univ, Fac Hlth Sci, Burnaby, BC, Canada

[7] Providence Hlth Care, Div Cardiol, Vancouver, BC, Canada

[8] Dept Internal Med, Div Endocrinol, Istanbul, Turkey

[9] King Saud Univ, Dept Cardiac Sci, Coll Med, King Fahad Cardiac Ctr, Riyadh, Saudi Arabia

[10] Univ Teknol MARA, Dept Med, Sungai Buloh, Selangor, Malaysia

[11] UCSI Univ, Dept Med, Cheras, Selangor, Malaysia

[12] Univ Kebangsaan Malaysia, Dept Community Hlth, Fac Med, Kuala Lumpur, Malaysia

[13] St Johns Med Coll & Res Inst, Div Epidemiol & Populat Hlth, Bangalore, Karnataka, India

[14] Univ Santander UDES, Masira Res Inst, Bucaramanga, Colombia

[15] Univ Zimbabwe, Physiol Dept, Coll Hlth Sci, Harare, Zimbabwe

[16] Univ Philippines Manila, UP Coll Med, Manila, Philippines

[17] Aga Khan Univ, Dept Community Hlth Sci & Med, Karachi, Pakistan

[18] Dubai Med Univ, Hatta Hosp, Dubai Hlth Author, Dubai, U Arab Emirates

[19] Northwest Univ, Dept Med, Africa Unit Transdisciplinary Hlth Res, Fac Hlth Sci, Mmabatho, South Africa

[20] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden

[21] Sahlgrens Univ Hosp, Reg Vastra Gotaland, Gothenburg, Sweden

[22] Isfahan Univ Med Sci, Cardiovasc Res Inst, Dept Med, Hypertens Res Ctr, Esfahan, Iran

[23] Wroclaw Med Univ, Dept Social Med, Wroclaw, Poland

[24] Queens Univ, Dept Med, Kingston, ON, Canada

[25] Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India

[26] Natl Ctr Cardiovasc Dis, Med Res & Biometr Ctr, Beijing, Peoples R China

[27] Nanchang Cty Ctr Dis Prevent & Control, Nanchang, Jiangxi, Peoples R China

[28] Independent Univ, Dhaka, Bangladesh

[29] Post Grad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh, India

[30] Hlth Act People & Govt Med Coll, Thiruvanthapuram, Kerala, India

[31] Hosp Alemao Oswaldo Cruz, Sao Paulo, Brazil

[32] Univ Santo Amaro, Sao Paulo, Brazil

[33] Inst Cardiovasc Rosario, Estudios Clin Latino Amer, Rosario, Santa Fe, Argentina

[34] Univ La Frontera, Temuco, Chile

来源：

DIABETES CARE | 2020年 / 43卷 / 12期

基金：

加拿大健康研究院;

关键词：

TRENDS; DISEASE; OUTCOMES; AFFORDABILITY; AVAILABILITY; MEDICINES; ADULTS; RISK;

D O I：

10.2337/dc20-0886

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 +/- 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.

引用

页码：3094 / 3101

页数：8

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