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Bishop K, Balogun S, Eynstone-Hinkins J, Moran L, Martin M, Banks E, Rao C, Joshy G. Analysis of Multiple Causes of Death: A Review of Methods and Practices. Epidemiology 2023; 34:333-344. [PMID: 36719759 PMCID: PMC10069753 DOI: 10.1097/ede.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics-reflecting increasing multimorbidity and complex causation patterns-is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes. METHODS We searched Medline, PubMed, Scopus, and Web of Science from their incept ion to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles. RESULTS Most articles we reviewed (76%, n = 332) were published since 2001. The majority of articles examined mortality by "any- mention" of the cause of death (87%, n = 377) and assessed pairwise combinations of causes (57%, n = 245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n = 9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n = 5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently. CONCLUSION This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
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Affiliation(s)
- Karen Bishop
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Saliu Balogun
- From the National Centre for Epidemiology and Population Health, Australian National University
| | | | - Lauren Moran
- Australian Bureau of Statistics, Canberra, Australia
| | - Melonie Martin
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Emily Banks
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Chalapati Rao
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Grace Joshy
- From the National Centre for Epidemiology and Population Health, Australian National University
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2
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Bishop K, Moreno-Betancur M, Balogun S, Eynstone-Hinkins J, Moran L, Rao C, Banks E, Korda RJ, Gourley M, Joshy G. Quantifying cause-related mortality in Australia, incorporating multiple causes: observed patterns, trends and practical considerations. Int J Epidemiol 2022; 52:284-294. [PMID: 35984318 PMCID: PMC9908048 DOI: 10.1093/ije/dyac167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mortality statistics using a single underlying cause of death (UC) are key health indicators. Rising multimorbidity and chronic disease mean that deaths increasingly involve multiple conditions. However, additional causes reported on death certificates are rarely integrated into mortality indicators, partly due to complexities in data and methods. This study aimed to assess trends and patterns in cause-related mortality in Australia, integrating multiple causes (MC) of death. METHODS Deaths (n = 1 773 399) in Australia (2006-17) were mapped to 136 ICD-10-based groups and MC indicators applied. Age-standardized cause-related rates (deaths/100 000) based on the UC (ASRUC) were compared with rates based on any mention of the cause (ASRAM) using rate ratios (RR = ASRAM/ASRUC) and to rates based on weighting multiple contributing causes (ASRW). RESULTS Deaths involved on average 3.4 causes in 2017; the percentage with >4 causes increased from 20.9 (2006) to 24.4 (2017). Ischaemic heart disease (ASRUC = 73.3, ASRAM = 135.8, ASRW = 63.5), dementia (ASRUC = 51.1, ASRAM = 98.1, ASRW = 52.1) and cerebrovascular diseases (ASRUC = 39.9, ASRAM = 76.7, ASRW = 33.5) ranked as leading causes by all methods. Causes with high RR included hypertension (ASRUC = 2.2, RR = 35.5), atrial fibrillation (ASRUC = 8.0, RR = 6.5) and diabetes (ASRUC = 18.5, RR = 3.5); the corresponding ASRW were 12.5, 12.6 and 24.0, respectively. Renal failure, atrial fibrillation and hypertension ranked among the 10 leading causes by ASRAM and ASRW but not by ASRUC. Practical considerations in working with MC data are discussed. CONCLUSIONS Despite the similarities in leading causes under the three methods, with integration of MC several preventable diseases emerged as leading causes. MC analyses offer a richer additional perspective for population health monitoring and policy development.
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Affiliation(s)
- Karen Bishop
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Margarita Moreno-Betancur
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, VIC, Australia,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Saliu Balogun
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - James Eynstone-Hinkins
- Health and Vital Statistics Section, Australian Bureau of Statistics, Canberra, ACT, Australia
| | - Lauren Moran
- Health and Vital Statistics Section, Australian Bureau of Statistics, Canberra, ACT, Australia
| | - Chalapati Rao
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Michelle Gourley
- Population Health Group, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Grace Joshy
- Corresponding author. National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, 62 Mills Road, Acton ACT 2601, Australia. E-mail:
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3
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All-cause mortality prediction in T2D patients with iTirps. Artif Intell Med 2022; 130:102325. [DOI: 10.1016/j.artmed.2022.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
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Liang D, Mai H, Ruan F, Fu H. The Efficacy of Triptolide in Preventing Diabetic Kidney Diseases: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:728758. [PMID: 34658869 PMCID: PMC8517526 DOI: 10.3389/fphar.2021.728758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/09/2022] Open
Abstract
Ethnopharmacological Relevance: Triptolide (TP), the primary biologically active ingredient of Tripterygium wilfordii Hook F (TWHF), possesses the potential to solve the shortcomings of TWHF in treating diabetic kidney disease (DKD) in the clinic. Aim of the Study: We conducted a meta-analysis to evaluate the efficacy of TP in treating DKD and offer solid evidence for further clinical applications of TP. Materials and Methods: Eight databases (CNKI, VIP, CBM, WanFang, PubMed, Web of Science, EMBASE, and Cochrane library) were electronically searched for eligible studies until October 17, 2020. We selected animal experimental studies using TP versus renin–angiotensin system inhibitors or nonfunctional liquids to treat DKD by following the inclusion and exclusion criteria. Two researchers independently extracted data from the included studies and assessed the risk of bias with the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias tool. Fixed-effects meta-analyses, subgroup analyses, and meta-regression were conducted using RevMan 5.3 software. Inplasy registration number: INPLASY2020100042. Results: Twenty-six studies were included. Meta-analysis showed that TP significantly reduced albuminuria (14 studies; standardized mean difference SMD: −1.44 [−1.65, −1.23], I2 = 87%), urine albumin/urine creatinine ratio (UACR) (8 studies; SMD: –5.03 [–5.74, −4.33], I2 = 84%), total proteinuria (4 studies; SMD: –3.12 [–3.75, −2.49], I2 = 0%), serum creatinine (18 studies; SMD: –0.30 [–0.49, −0.12], I2 = 76%), and blood urea nitrogen (12 studies; SMD: –0.40 [–0.60, −0.20], I2 value = 55%) in DKD animals, compared to the vehicle control. However, on comparing TP to the renin–angiotensin system (RAS) inhibitors in DKD treatment, there was no marked difference in ameliorating albuminuria (3 studies; SMD: –0.35 [–0.72, 0.02], I2 = 41%), serum creatinine (3 studies; SMD: –0.07 [–0.62, 0.48], I2 = 10%), and blood urea nitrogen (2 studies; SMD: –0.35 [–0.97, 0.28], I2 = 0%). Of note, TP exhibited higher capacities in reducing UACR (2 studies; SMD: –0.66 [–1.31, −0.01], I2 = 0%) and total proteinuria (2 studies; SMD: –1.18 [–1.86, −2049], I2 = 0%). Meta-regression implicated that the efficacy of TP in reducing DKD albuminuria was associated with applied dosages. In addition, publication bias has not been detected on attenuating albuminuria between TP and RAS inhibitors after the diagnosis of DKD. Systematic Review Registration:https://clinicaltrials.gov/, identifier INPLASY2020100042
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Affiliation(s)
- Dongning Liang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First Medical College, Southern Medical University, Guangzhou, China
| | - Hanwen Mai
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First Medical College, Southern Medical University, Guangzhou, China
| | - Fangyi Ruan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The First Medical College, Southern Medical University, Guangzhou, China
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Shi Y, Huang C, Yi H, Cao Q, Zhao Y, Chen J, Chen X, Pollock C. RIPK3 blockade attenuates kidney fibrosis in a folic acid model of renal injury. FASEB J 2020; 34:10286-10298. [PMID: 32542792 DOI: 10.1096/fj.201902544rr] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022]
Abstract
Renal fibrosis is common to all forms of progressive kidney disease. However, current therapies to limit renal fibrosis are largely ineffective. Phosphorylation of receptor-interacting serine/threonine-protein kinase (RIPK) 3 has been recently suggested to be a key regulator of the pyrin domain containing 3 (NLRP3) inflammasome, which provides new insights into mechanisms of chronic kidney disease (CKD). However, the specific effect of RIPK3 on renal cortical fibrosis has not been fully understood. To study the function of RIPK3, both genetic ablation and pharmacological inhibition of RIPK3 (dabrafenib) were used in the study. Our studies identify that RIPK3 promotes renal fibrosis via the activation of the NLRP3 inflammasome in a mouse model of folic acid-induced nephropathy. Both interventional strategies decreased the renal fibrotic response, and beneficial effects converged on the NLRP3 inflammasome. This study demonstrates a role for RIPK3 as the mediator of renal fibrosis via the upregulation of inflammasome activation. Dabrafenib, as an inhibitor of RIPK3, may be an effective treatment to limit the progression of the tubulointerstitial fibrosis.
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Affiliation(s)
- Ying Shi
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Chunling Huang
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Hao Yi
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Qinghua Cao
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Yongli Zhao
- Department of Pediatrics, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jason Chen
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Xinming Chen
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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García-Molina L, Lewis-Mikhael AM, Riquelme-Gallego B, Cano-Ibáñez N, Oliveras-López MJ, Bueno-Cavanillas A. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur J Nutr 2019; 59:1313-1328. [PMID: 31781857 DOI: 10.1007/s00394-019-02147-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus. METHODS We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus. RESULTS A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = - 0.51 (- 0.67, - 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = - 0.95 (- 1.24, - 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed. CONCLUSIONS The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.
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Affiliation(s)
- Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Anne-Mary Lewis-Mikhael
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
- High Institute of Pubic Health, Alexandria University, 165 El-Horreya Avenue - El-Ibrahimia, Alexandria, Egypt
| | - Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Avenida de Madrid, 15, 18018, Granada, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - María-Jesús Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de Granada, Avenida de Madrid, 15, 18018, Granada, Spain
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Jeyaraman K, Berhane T, Hamilton M, Chandra AP, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord 2019; 19:1. [PMID: 30606164 PMCID: PMC6318899 DOI: 10.1186/s12902-018-0327-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear. METHODS All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression. RESULTS In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%). CONCLUSION Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.
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Affiliation(s)
- Kanakamani Jeyaraman
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory Australia
| | - Thomas Berhane
- Department of Prosthetics and Orthotics, Royal Darwin Hospital, Darwin, Northern Territory Australia
| | - Mark Hamilton
- Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
| | - Abhilash P. Chandra
- Department of Vascular Surgery, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory Australia
- Menzies School of Health Research, Darwin, NT Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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8
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Twig G, Vivante A, Bader T, Derazne E, Tsur AM, Levi M, Goldberger N, Leiba A, Kark JD. Body Mass Index and Kidney Disease-Related Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents. Obesity (Silver Spring) 2018; 26:776-781. [PMID: 29498231 DOI: 10.1002/oby.22144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/29/2017] [Accepted: 01/26/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association of body mass index (BMI) in adolescence with mortality attributed to kidney disease. METHODS In this study, 2,294,139 Jewish Israeli adolescents with measured weight and height at 17 years old during the military fitness assessment were analyzed with a follow-up extending up to 45 years. All kidney-related outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied. RESULTS During 42,297,007 person-years of follow-up (median 18.4 years), 226 deaths related to kidney disease were recorded. There was an increased risk for kidney-related death among adolescents with overweight and obesity with adjusted hazard ratios of 2.7 (95% CI: 1.8-3.9) and 8.4 (5.1-13.8), respectively, with BMI between 18.5 and 22.0 kg/m2 as the reference. A 15% increased risk for kidney-related mortality (1.11-1.19) per unit increment in BMI was observed. Furthermore, a multivariable spline model indicated a minimum risk for kidney-related mortality starting at BMI of 18.6 kg/m2 with significantly increased risk seen above values of 22.8 kg/m2 . The results withstood extensive sensitivity analyses, including stratification of kidney-related death attributed to acute, chronic, and total kidney disease. CONCLUSIONS Adolescent overweight and obesity are risk markers for kidney-related mortality over 4 decades.
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Affiliation(s)
- Gilad Twig
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Vivante
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Sheba Medical Center, Tel Hashomer, Israel
| | - Tarif Bader
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Estela Derazne
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishai M Tsur
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Moran Levi
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | | | - Adi Leiba
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
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Kumar V, Yadav AK, Gang S, John O, Modi GK, Ojha JP, Pandey R, Parameswaran S, Prasad N, Sahay M, Varughese S, Baid-Agarwal S, Jha V. Indian chronic kidney disease study: Design and methods. Nephrology (Carlton) 2017; 22:273-278. [DOI: 10.1111/nep.12789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Vivek Kumar
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ashok Kumar Yadav
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Sishir Gang
- Muljibhai Patel Urological Hospital; Nadiad India
| | - Oommen John
- George Institute for Global Health; New Delhi India
| | - Gopesh K Modi
- Samarpan Kidney Institute and Research Center; Bhopal India
| | - Jai Prakash Ojha
- Department of Nephrology, Institute of Medical Science; Banaras Hindu University; Varanasi India
| | - Rajendra Pandey
- Department of Nephrology; Institute of Post Graduate Medical Education & Research; Kolkata India
| | - Sreejith Parameswaran
- Department of Nephrology; Jawaharlal Institute of Postgraduate Medical Education & Research; Pondicherry India
| | - Narayan Prasad
- Department of Nephrology; Sanjay Gandhi Postgraduate Institute of Medical Science; Lucknow India
| | - Manisha Sahay
- Department of Nephrology; Osmania Medical College, Osmania General Hospital; Hyderabad India
| | | | - Seema Baid-Agarwal
- Department of Nephrology and Transplant Center; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Vivekanand Jha
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
- George Institute for Global Health; New Delhi India
- University of Oxford; Oxford UK
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Lotufo PA. Renal disease screening: a potential tool for reducing health inequity. SAO PAULO MED J 2016; 134:1-2. [PMID: 27027808 PMCID: PMC10496586 DOI: 10.1590/1516-3180.2016.13411512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Paulo Andrade Lotufo
- MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.Universidade de São PauloDepartment of Internal MedicineFaculdade de MedicinaUniversidade de São PauloSão PauloBrazil
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11
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Fedeli U, Zoppini G, Goldoni CA, Avossa F, Mastrangelo G, Saugo M. Multiple causes of death analysis of chronic diseases: the example of diabetes. Popul Health Metr 2015; 13:21. [PMID: 26309427 PMCID: PMC4549015 DOI: 10.1186/s12963-015-0056-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases. METHODS The whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors. RESULTS In the whole mortality archive, diabetes was mentioned in 12.3 % of death certificates, and selected as the UCOD in 2.9 %. The death rate for diabetes as the UCOD was 26.8 × 10(5) against 112.6 × 10(5) for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1 %, and selected as the UCOD in 13.4 %. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm. CONCLUSIONS The use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, Padova (PD), 35131 Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Piazzale Stefani 1, Verona (VR), 37126 Italy
| | - Carlo Alberto Goldoni
- Department of Public Health, Local Health Unit, Modena, Strada Martiniana 21, Baggiovara, Modena (MO), 41126 Italy
| | - Francesco Avossa
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, Padova (PD), 35131 Italy
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, Padova (PD), 35128 Italy
| | - Mario Saugo
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, Padova (PD), 35131 Italy
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Ozieh MN, Dismuke CE, Lynch CP, Egede LE. Medical care expenditures associated with chronic kidney disease in adults with diabetes: United States 2011. Diabetes Res Clin Pract 2015; 109:185-90. [PMID: 25935258 PMCID: PMC7518639 DOI: 10.1016/j.diabres.2015.04.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/26/2015] [Accepted: 04/12/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Approximately 1 in 3 adults with diabetes have CKD. However, there are no recent national estimates of the association of CKD with medical care expenditures in individuals with diabetes. Our aim is to assess the association of CKD with total medical expenditures in US adults with diabetes using a national sample and novel cost estimation methodology. RESEARCH DESIGN AND METHODS Data on 2,053 adults with diabetes in the 2011 Medical Expenditure Panel Survey (MEPS) was analyzed. Individuals with CKD were identified based on self-report. Adjusted mean health services expenditures per person in 2011 were estimated using a two-part model after adjusting for demographic and clinical covariates. RESULTS Of the 2,053 individuals with diabetes, approximately 9.7% had self-reported CKD. Unadjusted mean expenditures for individuals with CKD were $20,726 relative to $9,689.49 for no CKD. Adjusted mean expenditures from the 2-part model for individuals with CKD were $8473 higher relative to individuals without CKD. Additional significant covariates were Hispanic/other race, uninsured, urban dwellers, CVD, stroke, high cholesterol, arthritis, and asthma. The estimated unadjusted total expenditures for individuals with CKD were estimated to be in excess of $43 billion in 2011. CONCLUSIONS We showed that CKD is a significant contributor to the financial burden among individuals with diabetes, and that minorities and the uninsured with CKD may experience barriers in access to care. Our study also provides a baseline national estimate of CKD cost in Diabetes by which future studies can be used for comparison.
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Affiliation(s)
- Mukoso N Ozieh
- Medical University of South Carolina, Division of Nephrology, Charleston, SC. USA; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Clara E Dismuke
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Cheryl P Lynch
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Leonard E Egede
- Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
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Renard F, Tafforeau J, Deboosere P. Mapping the cause-specific premature mortality reveals large between-districts disparity in Belgium, 2003-2009. Arch Public Health 2015; 73:13. [PMID: 25922667 PMCID: PMC4412101 DOI: 10.1186/s13690-015-0060-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/06/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Reducing premature mortality is a crucial public health objective. The goal of this paper, beside updating previous mortality atlases with recent data, is to explore the relative between-districts disparity using a relative-scale map design. METHODS Causes of deaths and population data were provided by Statistics Belgium. All deaths occurring in the periods 1993-1999 and 2003-2009, in people aged 1-74 residing in Belgium were included. Age-adjusted rates by cause of death were computed for both periods; the 2003-2009 rates were classified using a relative scale with a 10% change between each level and represented on chloropleths maps with a green-to-red divergent colour scheme centred on the national mean. This particular design allows the comparability across all the maps since a same meaning is given to a specific colour. The variation coefficient and the decile ratio were calculated and compared between the 2 periods. RESULTS A clear-cut regional divide at the disadvantage of Wallonia, and to some extent, of Brussels, was seen for all-cause, cardiovascular, cerebrovascular, diabetes, alcohol-related, mental and neurological diseases and non-transport accidents premature mortality. A NE-SW pattern parallel to the French border was observed for Lip, Oral Cavity, Pharynx, Larynx and oesophageal cancers, while various patterns are observed for the other cancers. The highest rates of road accident mortality are observed in the Southern districts. Many of those patterns are in continuity with earlier observations. However, the pattern of diabetes and mental and neurological diseases are new features. The variation coefficient and the decile ratios increased by 10% between the 1993-1997 and 2003-2009 periods. CONCLUSIONS The use of a relative scale in the maps highlights the importance of the between-districts disparity in premature mortality, with for most causes, a clear-cut regional divide at the disadvantage of Wallonia; this health gap results of complex interactions between various factors, including the socioeconomic context, cultural habits and environmental influences, as well as public health policies. It should be considered as a warning signal, warranting the attention of the policy makers. Meanwhile, these results also highlight the potential for improvement in the more disadvantaged regions.
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Affiliation(s)
- Françoise Renard
- />Department Public Health and Surveillance, Institute of Public Health, Brussels, Belgium
| | - Jean Tafforeau
- />Department Public Health and Surveillance, Institute of Public Health, Brussels, Belgium
| | - Patrick Deboosere
- />Interface Demography, Section Social Research, Free University of Brussels, Brussels, Belgium
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Doi SAR, Barendregt JJ, Rao C. An updated method for risk adjustment in outcomes research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:629-633. [PMID: 25128057 DOI: 10.1016/j.jval.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To demonstrate why meta-analytic methods need modification before they can be used to aggregate rates or effect sizes in outcomes research, under the constraint of no common underlying effect or rate. METHODS Studies are presented that require different types of risk adjustment. First, we demonstrate using rates that external risk adjustment through standardization can be achieved using modified meta-analytic methods, but only with a model that allows input of user-defined weights. Next, we extend these observations to internal risk adjustment of comparative effect sizes. RESULTS We show that this procedure produces identical results to conventional age standardization if a rate is being standardized for age. We also demonstrate that risk adjustment of effect sizes can be achieved with this modified method but cannot be done using standard meta-analysis. CONCLUSIONS We conclude that this method allows risk adjustment to be performed in situations in which currently the fixed- or random-effects methods of meta-analysis are inappropriately used. The latter should be avoided when the underlying aim is risk adjustment rather than meta-analysis.
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Affiliation(s)
- Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Australia.
| | - Jan J Barendregt
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Chalapati Rao
- School of Population Health, University of Queensland, Brisbane, Australia
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Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AYM, Yang CW. Chronic kidney disease: global dimension and perspectives. Lancet 2013; 382:260-72. [PMID: 23727169 DOI: 10.1016/s0140-6736(13)60687-x] [Citation(s) in RCA: 2606] [Impact Index Per Article: 236.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and is an increasing public health issue. Prevalence is estimated to be 8-16% worldwide. Complications include increased all-cause and cardiovascular mortality, kidney-disease progression, acute kidney injury, cognitive decline, anaemia, mineral and bone disorders, and fractures. Worldwide, diabetes mellitus is the most common cause of chronic kidney disease, but in some regions other causes, such as herbal and environmental toxins, are more common. The poorest populations are at the highest risk. Screening and intervention can prevent chronic kidney disease, and where management strategies have been implemented the incidence of end-stage kidney disease has been reduced. Awareness of the disorder, however, remains low in many communities and among many physicians. Strategies to reduce burden and costs related to chronic kidney disease need to be included in national programmes for non-communicable diseases.
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Affiliation(s)
- Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Vessières E, Belin de Chantemèle EJ, Guihot AL, Jardel A, Toutain B, Loufrani L, Henrion D. Cyclooxygenase-2-derived prostanoids reduce inward arterial remodeling induced by blood flow reduction in old obese Zucker rat mesenteric arteries. Vascul Pharmacol 2013; 58:356-62. [PMID: 23524072 DOI: 10.1016/j.vph.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 12/11/2022]
Abstract
Obesity is associated with altered arterial structure and function leading to arterial narrowing in most vascular beds, especially when associated with aging. Nevertheless, mesenteric blood flow remains elevated in obese rats, although the effect of aging remains unknown. We investigated mesenteric artery narrowing following blood flow reduction in vivo in 3- and 12-month-old obese Zucker rats. After 21 days, inward remodeling occurred in low flow (LF) arteries in young and old lean rats and in young obese rats (30% diameter reduction). Diameter did not significantly decrease in old obese rats. Phenylephrine-mediated contraction was reduced by approximately 20% in LF arteries in all groups but in old obese rat arteries in which the decrease reached 80%. LF arteries expressed cyclooxygenase-2 and blood 6-keto-PGF1alpha (prostacyclin metabolite) was elevated in old obese rats. In old obese rats, acute cyclooxygenase-2 blockade restored phenylephrine-mediated contraction in LF arteries and chronic cyclooxygenase-2 blockade restored inward remodeling and contractility to control level. Thus, in old obese rats, cyclooxygenase-2-derived prostacyclin prevented the diameter reduction induced by a chronic decrease in blood flow. This adaptation is in favor of a preserved perfusion of the mesentery by contrast with other vascular territories, possibly amplifying the vascular disorders occurring in obesity.
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Rao C, Doi SA. Measuring population-based diabetes-related mortality: a summary of requirements. J Clin Epidemiol 2013. [DOI: 10.1016/j.jclinepi.2012.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Raaschou-Nielsen O, Sørensen M, Ketzel M, Hertel O, Loft S, Tjønneland A, Overvad K, Andersen ZJ. Long-term exposure to traffic-related air pollution and diabetes-associated mortality: a cohort study. Diabetologia 2013; 56:36-46. [PMID: 22918192 DOI: 10.1007/s00125-012-2698-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 07/25/2012] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate whether air pollution from traffic at a residence is associated with mortality related to type 1 or type 2 diabetes. METHODS We followed up 52,061 participants in the Danish Diet, Cancer and Health cohort for diabetes-related mortality in the nationwide Register of Causes of Death, from baseline in 1993-1997 up to the end of 2009, and traced their residential addresses since 1971 in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO₂) since 1971 and amount of traffic at the baseline residence as indicators of traffic-related air pollution and used Cox regression models to estimate mortality-rate ratios (MRRs) with adjustment for potential confounders. RESULTS Mean levels of NO₂ at the residence since 1971 were significantly associated with mortality from diabetes. Exposure above 19.4 μg/m³ (upper quartile) was associated with a MRR of 2.15 (95% CI 1.21, 3.83) when compared with below 13.6 μg/m³ (lower quartile), corresponding to an MRR of 1.31 (95% CI 0.98, 1.76) per 10 μg/m³ NO₂ after adjustment for potential confounders. CONCLUSIONS/INTERPRETATION This study suggests that traffic-related air pollution is associated with mortality from diabetes. If confirmed, reduction in population exposure to traffic-related air pollution could be an additional strategy against the global public health burden of diabetes.
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Affiliation(s)
- O Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.
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Icks A, Haastert B, Genz J, Giani G, Hoffmann F, Trapp R, Koch M. Time-dependent impact of diabetes on the mortality of patients on renal replacement therapy: a population-based study in Germany (2002-2009). Diabetes Res Clin Pract 2011; 92:380-5. [PMID: 21420753 DOI: 10.1016/j.diabres.2011.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 11/15/2022]
Abstract
AIMS To estimate the impact of diabetes on the mortality of patients with incident renal replacement therapy (RRT). METHODS We assessed the mortality of 544 incident RRT patients aged ≥ 30 years between 2002 and 2009 (57.9% men, mean age 70.3 years, 49.6% patients with diabetes) by analyzing the data of all dialysis centers covering a German region. We compared the estimated time-dependent hazard ratios of patients with and without diabetes by using the Cox proportional-hazards regression model. RESULTS Overall, 319 patients had died (158 diabetic), approximately 50% after 3 years. Up to about 3 years, the mortality rate was lower in diabetic than in nondiabetic patients. Thereafter, the survival curves crossed (interaction diabetes × time, p = 0.002; adjusted hazard ratios for diabetes: baseline, 0.66; year 1, 0.84; year 2, 1.05; year 3, 1.33; year 4, 1.68). The results were similar in men and women; however, the interaction of diabetes and time was significant only in men (p = 0.004). Further significant risk factors of mortality were age, sex, initial central venous catheter, cardiovascular disease, and malignancy. CONCLUSIONS In this population-based study, the influence of diabetes was time-dependent, with a lower mortality in diabetic versus non-diabetic patients in the first three years but a higher mortality in these patients after 3 years. Results were similar in men and women.
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Affiliation(s)
- Andrea Icks
- Department of Public Health, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
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