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Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.

Publication ,  Journal Article
Bragg, F; Holmes, MV; Iona, A; Guo, Y; Du, H; Chen, Y; Bian, Z; Yang, L; Herrington, W; Bennett, D; Turnbull, I; Liu, Y; Feng, S; Chen, J ...
Published in: JAMA
January 17, 2017

IMPORTANCE: In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. OBJECTIVES: To assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China. DESIGN, SETTING, AND PARTICIPANTS: A 7-year nationwide prospective study of 512 869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014. EXPOSURES: Diabetes (previously diagnosed or detected by screening) recorded at baseline. MAIN OUTCOMES AND MEASURES: All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline. RESULTS: Among the 512 869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n = 302 618) were women, and 5.9% (n = 30 280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24 909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100 000; adjusted RR, 2.00 [95% CI, 1.93-2.08]), which was higher in rural areas than in urban areas (rural RR, 2.17 [95% CI, 2.07-2.29]; urban RR, 1.83 [95% CI, 1.73-1.94]). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 [95% CI, 2.19-2.63]), stroke (4444 deaths; RR, 1.98 [95% CI, 1.81-2.17]), chronic liver disease (481 deaths; RR, 2.32 [95% CI, 1.76-3.06]), infections (425 deaths; RR, 2.29 [95% CI, 1.76-2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95% CI, 1.28-1.86]), pancreas (357 deaths; RR, 1.84 [95% CI, 1.35-2.51]), female breast (217 deaths; RR, 1.84 [95% CI, 1.24-2.74]), and female reproductive system (210 deaths; RR, 1.81 [95% CI, 1.20-2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 [95% CI, 14.22-24.57]) than in urban areas (6.83 [95% CI, 4.73-9.88]). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). CONCLUSIONS AND RELEVANCE: Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

January 17, 2017

Volume

317

Issue

3

Start / End Page

280 / 289

Location

United States

Related Subject Headings

  • Urban Population
  • Stroke
  • Sex Distribution
  • Rural Population
  • Renal Insufficiency, Chronic
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Pancreatic Diseases
  • Myocardial Ischemia
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Bragg, F., Holmes, M. V., Iona, A., Guo, Y., Du, H., Chen, Y., … China Kadoorie Biobank Collaborative Group, . (2017). Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China. JAMA, 317(3), 280–289. https://doi.org/10.1001/jama.2016.19720
Bragg, Fiona, Michael V. Holmes, Andri Iona, Yu Guo, Huaidong Du, Yiping Chen, Zheng Bian, et al. “Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.JAMA 317, no. 3 (January 17, 2017): 280–89. https://doi.org/10.1001/jama.2016.19720.
Bragg F, Holmes MV, Iona A, Guo Y, Du H, Chen Y, et al. Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China. JAMA. 2017 Jan 17;317(3):280–9.
Bragg, Fiona, et al. “Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.JAMA, vol. 317, no. 3, Jan. 2017, pp. 280–89. Pubmed, doi:10.1001/jama.2016.19720.
Bragg F, Holmes MV, Iona A, Guo Y, Du H, Chen Y, Bian Z, Yang L, Herrington W, Bennett D, Turnbull I, Liu Y, Feng S, Chen J, Clarke R, Collins R, Peto R, Li L, Chen Z, China Kadoorie Biobank Collaborative Group. Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China. JAMA. 2017 Jan 17;317(3):280–289.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

January 17, 2017

Volume

317

Issue

3

Start / End Page

280 / 289

Location

United States

Related Subject Headings

  • Urban Population
  • Stroke
  • Sex Distribution
  • Rural Population
  • Renal Insufficiency, Chronic
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Pancreatic Diseases
  • Myocardial Ischemia
  • Middle Aged