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Diabetes and the Risk of Infection-Related Mortality in the U.S.

¹ Department of Medicine, School of Medicine
² Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE—To determine whether diabetes predicts infection-related mortality and to clarify the extent to which this relationship is mediated by comorbid conditions that may themselves increase risk of infection.

RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using the Second National Health and Nutrition Examination Survey Mortality Study of 9,208 adults aged 30–74 years in 1976–1980. We defined demographic variables, diabetes, cardiovascular disease (CVD), and smoking by self-report; BMI, blood pressure, and serum cholesterol from baseline examination; and cause-specific mortality from death certificates.

RESULTS—Over 12–16 years of follow-up, 36 infection-related deaths occurred among 533 adults with diabetes vs. 265 deaths in 8,675 adults without diabetes (4.7 vs. 1.5 per 1,000 person-years, P < 0.001). Diabetes (RR 2.0, 95% CI 1.2–3.2) and congestive heart failure (2.8, 1.6–5.1) were independent predictors of infection-related mortality after simultaneous adjustment for age, sex, race, poverty status, smoking, BMI, and hypertension. After subdividing infection-related deaths into those with (n = 145) and without (n = 156) concurrent cardiovascular diagnoses at the time of death, diabetic adults were at risk for infection-related death with CVD (3.0, 1.8–5.0) but not without CVD (1.0, 0.5–2.2).

CONCLUSIONS—These nationally representative data suggest that diabetic adults are at greater risk for infection-related mortality, and the excess risk may be mediated by CVD.

Abbreviations: CHF, congestive heart failure • CVD, cardiovascular disease • ICD9, International Classification of Diseases, 9th revision • NHANES II, Second National Health and Nutrition Examination Survey

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