부산대학교 도서관

Background: The prevalence of type 2 diabetes has increased in both young and old people. We examined age-specific associations and population attributable fractions (PAFs) of risk factors for all-cause and cause-specific mortality in people with type 2 diabetes. Methods and findings: We analysed data from 360,202 Chinese with type 2 diabetes who participated in a territory-wide diabetes complication screening programme in Hong Kong between January 2000 and December 2019. We compared the hazard ratios and PAFs of eight risk factors, including three major comorbidities (cardiovascular disease [CVD], chronic kidney disease [CKD], all-site cancer) and five modifiable risk factors (suboptimal HbA1c, suboptimal blood pressure, suboptimal low-density lipoprotein cholesterol, smoking, and suboptimal weight), for mortality across four age groups (18 to 54, 55 to 64, 65 to 74, and ≥75 years). During a median 6.0 years of follow-up, 44,396 people died, with cancer, CVD, and pneumonia being the leading causes of death. Despite a higher absolute mortality risk in older people (crude all-cause mortality rate: 59.7 versus 596.2 per 10,000 person-years in people aged 18 to 54 years versus those aged ≥75 years), the relative risk of all-cause and cause-specific mortality associated with most risk factors was higher in younger than older people, after mutually adjusting for the eight risk factors and other potential confounders including sex, diabetes duration, lipid profile, and medication use. The eight risk factors explained a larger proportion of mortality events in the youngest (PAF: 51.6%, 95% confidence interval [CI] [39.1%, 64.0%], p < 0.001) than the oldest (PAF: 35.3%, 95% CI [27.2%, 43.4%], p < 0.001) age group. Suboptimal blood pressure (PAF: 16.9%, 95% CI [14.7%, 19.1%], p < 0.001) was the leading attributable risk factor for all-cause mortality in the youngest age group, while CKD (PAF: 15.2%, 95% CI [14.0%, 16.4%], p < 0.001) and CVD (PAF: 9.2%, 95% CI [8.3%, 10.1%], p < 0.001) were the leading attributable risk factors in the oldest age group. The analysis was restricted to Chinese, which might affect the generalisability to the global population with differences in risk profiles. Furthermore, PAFs were estimated under the assumption of a causal relationship between risk factors and mortality. However, reliable causality was difficult to establish in the observational study. Conclusions: Major comorbidities and modifiable risk factors were associated with a greater relative risk for mortality in younger than older people with type 2 diabetes and their associations with population mortality burden varied substantially by age. These findings highlight the importance of early control of blood pressure, which could reduce premature mortality in young people with type 2 diabetes and prevent the onset of later CKD and related mortality at older ages. In a prospective cohort study including more than 360,000 people in Hong Kong, Dr. Andrea Luk and colleagues explore age-specific risk factors for all-cause and cause-specific mortality in type 2 diabetes. Author summary: Why was this study done?: Preventive strategies aiming at averting premature deaths in people with type 2 diabetes should target the most influential attributable risk factors at the population level. Both the prevalence of risk factors for mortality in people with type 2 diabetes and the strength of their associations with mortality vary by age. It is unclear whether leading attributable risk factors for all-cause and cause-specific mortality differ across different age groups in people with type 2 diabetes. What did the researchers do and find?: Using data from a territory-wide diabetes complication screening program in Hong Kong involving 360,202 people with type 2 diabetes, we estimated the population attributable fraction of eight risk factors for all-cause and cause-specific mortality across different age groups. The leading attributable risk factors for all-cause and cause-specific mortality in people with type 2 diabetes varied by age. In the youngest age group of 18 to 54 years, the strongest attributable risk factor for all-cause mortality was suboptimal control of blood pressure. Among people aged ≥75 years, chronic kidney disease (CKD) accounted for the largest proportion of mortality events. What do these findings mean?: Intervention efforts should be targeted more specifically on the most important attributable risk factors in different age groups. Early control of blood pressure is important to reduce premature mortality in young people with type 2 diabetes and prevent the onset of later CKD and related mortality at older ages. [ABSTRACT FROM AUTHOR]