Cited by 384Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchHealthcare Systems and Public Health

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Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

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Baena-Díez, Jose Miguel, Peñafiel, Judit, Subirana, Isaac, Ramos, Rafel, Elosua, Roberto, Marín-Ibañez, Alejandro, Guembe, María Jesús, Rigo, Fernando, Tormo-Díaz, María José, Moreno-Iribas, Conchi, Cabré, Joan Josep, Segura, Antonio, García-Lareo, Manel, Gómez de la Cámara, Agustín, Lapetra, José, Quesada, Miquel, Marrugat, Jaume, Medrano, Maria José, Berjón, Jesús, Frontera, Guiem, Gavrila, Diana, Barricarte, Aurelio, Basora, Josep, García, Jose María, Pavone, Natalia C., Lora-Pablos, David, Mayoral, Eduardo, Franch, Josep, Mata, Manel, Castell, Conxa, Frances, Albert, Grau, María, on behalf of the FRESCO Investigators·2016·Diabetes Care

DOI 10.2337/dc16-0614

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Abstract

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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Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus
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Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus
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A Proportional Hazards Model for the Subdistribution of a Competing Risk
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Additional file 1 of Degree of joint risk factor control and hazard of mortality in diabetes patients: a matched cohort study in UK Biobank
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Additional file 1 of Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study
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Additional file 3 of Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study
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Additional file 2 of Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study
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Additional file 4 of Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study
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Additional file 5 of Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study
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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: Subirana, Isaac
Ramos, Rafel
Guembe, María Jesús
Lapetra, José
Quesada, Miquel
Marrugat, Jaume
Barricarte, Aurelio
Basora, Josep
Castell, Conxa
Grau, María
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
DOI: 10.2337/dc16-0614
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: other-oa
www.diabetesjournals.org/content/license (vor, 77 d)
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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