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All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry.

Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ - Diabetes Care (2010)

Bottom Line: The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]).Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]).Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT

Objective: Although management of type 1 diabetes improved dramatically in the 1980s, the effect on mortality is not clear.

Research design and methods: We report trends in 30-year mortality using the Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965-1979, by dividing the cohort into three diagnosis year cohorts (1965-1969, 1970-1974, and 1975-1979). Local (Allegheny County) mortality data were used to calculate standardized mortality ratios (SMRs).

Results: As of 1 January 2008, vital status was ascertained for 97.0% of participants (n = 1,043) when mean age ± SD and duration of diabetes were 42.8 ± 8.0 and 32.0 ± 7.6 years, respectively. The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]). An improving trend in SMR was seen by diagnosis cohort at 30 years of diabetes duration (9.3 [7.2-11.3], 7.5 [5.8-9.2], and 5.6 [4.0-7.2] for 1965-1969, 1970-1974, and 1975-1979, respectively). Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]). Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.

Conclusions: Although survival has clearly improved, those with diabetes diagnosed most recently (1975-1979) still had a mortality rate 5.6 times higher than that seen in the general population, revealing a continuing need for improvements in treatment and care, particularly for women and African Americans with type 1 diabetes.

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Related in: MedlinePlus

SMRs and 95% CIs for the overall (A) Allegheny County Type 1 Diabetes Registry cohort and by sex (B), race (C), and diagnosis cohort (D) at 5-year intervals of follow-up. C and D are spaced around the 5-year intervals for visual clarity; however, all SMRs are calculated at the same 5-year follow-up points.
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Figure 2: SMRs and 95% CIs for the overall (A) Allegheny County Type 1 Diabetes Registry cohort and by sex (B), race (C), and diagnosis cohort (D) at 5-year intervals of follow-up. C and D are spaced around the 5-year intervals for visual clarity; however, all SMRs are calculated at the same 5-year follow-up points.

Mentions: The SMRs over time (5-year follow-up intervals) are shown in Fig. 2 by sex, race, and diabetes diagnosis cohort. SMRs at 5-year follow-up are very high in the Allegheny County cohort, especially in women and in the earlier diagnosis cohorts (1965–1969 and 1970–1974). Mortality within the 1st year of diagnosis (onset mortality) was relatively common in this cohort (10 deaths) and occurred almost exclusively in women (n = 9), driving the extremely high female SMR at 5 years of follow-up. Women have consistently had SMRs of ≥10, whereas SMRs in men range between 1.8 and 5.0 over 30 years of follow-up (Fig. 2B). SMRs did not differ significantly by race but were consistently lower in African Americans over time (Fig. 2C). Steady improvements in SMRs have been seen over time between the 1965–1969 and 1975–1979 diagnosis cohorts, even after 30 years of type 1 diabetes duration (Fig. 2D).


All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry.

Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ - Diabetes Care (2010)

SMRs and 95% CIs for the overall (A) Allegheny County Type 1 Diabetes Registry cohort and by sex (B), race (C), and diagnosis cohort (D) at 5-year intervals of follow-up. C and D are spaced around the 5-year intervals for visual clarity; however, all SMRs are calculated at the same 5-year follow-up points.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992193&req=5

Figure 2: SMRs and 95% CIs for the overall (A) Allegheny County Type 1 Diabetes Registry cohort and by sex (B), race (C), and diagnosis cohort (D) at 5-year intervals of follow-up. C and D are spaced around the 5-year intervals for visual clarity; however, all SMRs are calculated at the same 5-year follow-up points.
Mentions: The SMRs over time (5-year follow-up intervals) are shown in Fig. 2 by sex, race, and diabetes diagnosis cohort. SMRs at 5-year follow-up are very high in the Allegheny County cohort, especially in women and in the earlier diagnosis cohorts (1965–1969 and 1970–1974). Mortality within the 1st year of diagnosis (onset mortality) was relatively common in this cohort (10 deaths) and occurred almost exclusively in women (n = 9), driving the extremely high female SMR at 5 years of follow-up. Women have consistently had SMRs of ≥10, whereas SMRs in men range between 1.8 and 5.0 over 30 years of follow-up (Fig. 2B). SMRs did not differ significantly by race but were consistently lower in African Americans over time (Fig. 2C). Steady improvements in SMRs have been seen over time between the 1965–1969 and 1975–1979 diagnosis cohorts, even after 30 years of type 1 diabetes duration (Fig. 2D).

Bottom Line: The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]).Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]).Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT

Objective: Although management of type 1 diabetes improved dramatically in the 1980s, the effect on mortality is not clear.

Research design and methods: We report trends in 30-year mortality using the Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965-1979, by dividing the cohort into three diagnosis year cohorts (1965-1969, 1970-1974, and 1975-1979). Local (Allegheny County) mortality data were used to calculate standardized mortality ratios (SMRs).

Results: As of 1 January 2008, vital status was ascertained for 97.0% of participants (n = 1,043) when mean age ± SD and duration of diabetes were 42.8 ± 8.0 and 32.0 ± 7.6 years, respectively. The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]). An improving trend in SMR was seen by diagnosis cohort at 30 years of diabetes duration (9.3 [7.2-11.3], 7.5 [5.8-9.2], and 5.6 [4.0-7.2] for 1965-1969, 1970-1974, and 1975-1979, respectively). Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]). Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.

Conclusions: Although survival has clearly improved, those with diabetes diagnosed most recently (1975-1979) still had a mortality rate 5.6 times higher than that seen in the general population, revealing a continuing need for improvements in treatment and care, particularly for women and African Americans with type 1 diabetes.

Show MeSH
Related in: MedlinePlus