Risk of cause-specific death in individuals with diabetes: a competing risks analysis
Open accessAbstract
OBJECTIVE: Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS: We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35–79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS: We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63–2.52) and PSH = 1.99 (1.60–2.49) in men; and CSH = 2.28 (1.75–2.97) and PSH = 2.23 (1.70–2.91) in women; 2) cancer death, CSH = 1.37 (1.13–1.67) and PSH = 1.35 (1.10–1.65) in men; and CSH = 1.68 (1.29–2.20) and PSH = 1.66 (1.25–2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23–1.91) and PSH = 1.50 (1.20–1.89) in men; and CSH = 1.89 (1.43–2.48) and PSH = 1.84 (1.39–2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS: Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
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People with diabetes have a higher risk of adverse cardiovascular outcomes than people without diabetes.
“People with diabetes are at heightened risk for developing adverse cardiovascular outcomes, compared with people without diabetes.”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [1]
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A review of air pollution as a driver of cardiovascular disease risk across the diabetes spectrum
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- Authors
- Baena-Díez, J. M., Peñafiel, J., Subirana, I., Ramos, R., Elosua, R., Marín-Ibañez, A., Guembe, M. J., Rigo, F., Tormo-Díaz, M. J., Moreno-Iribas, C., Cabré, J. J., Segura, A., García-Lareo, M., Gómez de la Cámara, A., Lapetra, J., Quesada, M., Marrugat, J., Medrano, M. J., Berjón, J., Frontera, G., Gavrila, D., Barricarte, A., Basora, J., García, J. M., Pavone, N. C., Lora-Pablos, D., Mayoral, E., Franch, J., Mata, M., Castell, C., Frances, A., Grau, M., & on behalf of the FRESCO Investigators
- Affiliations
- REGICOR Study Group–Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Hospital Del Mar (ES)
- Universitat de Girona (ES)
- San Jose Norte Health Centre, Zaragoza, Spain
- Gobierno de Navarra (ES)
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
- Servicio Murciano de Salud (ES)
- Navarre Public Health Institute, Pamplona, Spain
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (ES)
- Regional Government of Castile-La Mancha (ES)
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain
- Instituto de Salud Carlos III (ES)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
- Health Science Institute, Department of Health and Social Affairs, Castille–La Mancha Government, Talavera de la Reina, Spain
- Andalusian Health Service (ES)
- Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
- Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
- Generalitat de Catalunya (ES)
- Department of Urology, Hospital del Mar, Barcelona, Spain
- Corresponding author
- Grau, María
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2016-08-04
- Volume
- 39
- Issue
- 11
- Pages
- 1987-1995
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2475954707
- Cited by
- 384
- References
- 44
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 61 · 2023: 42 · 2022: 64 · 2021: 49 · 2020: 51 · 2019: 44 · 2018: 14 · 2017: 8 · 2016: 3
- FWCI
- 23.10
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Rovira & Virgili repository (submittedVersion, cc-by)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion)
- Hispana (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- Instituto de Salud Carlos III (FIS CP12/03287)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- diabetes mellitus, cause-specific mortality, competing risks, cardiovascular mortality, cancer mortality, premature mortality, cause-specific hazard, sex differences in mortality, life expectancy, cardiovascular risk factors, cancer risk factors, mortality risk factors
- MeSH terms
- Adult, Aged, Blood Glucose, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Life Expectancy, Male, Middle Aged, Neoplasms, Risk Factors, Cohort Studies, Multivariate Analysis, Risk Assessment
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