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

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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Affiliated Institutions

• Universitat de Girona ES
• Fundación Andrés Marcio ES
• Andalusian Health Service ES
• Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas ES
• Institut Universitari d'Investigació en Atenció Primària Jordi Gol ES
• Hospital del Mar Research Institute ES
• Research Institute Hospital 12 de Octubre ES
• Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública ES
• Instituto de Salud Carlos III ES
• Universidad de Murcia ES
• Generalitat de Catalunya ES
• Hospital Del Mar ES
• Government of Spain ES
• Universitat de Barcelona ES
• Spanish Clinical Research Network ES
• Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition ES

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