Risk Factors for Mortality among Patients with Diabetes: The Translating Research Into Action for Diabetes (TRIAD) Study
- Laura N. McEwen, PhD (lmattei{at}med.umich.edu)1,
- Catherine Kim, MD, MPH2,
- Andrew J. Karter, PhD3,
- Mary N. Haan, MPH, DrPH4,
- Debashis Ghosh, PhD5,
- Paula M. Lantz, PhD, MS6,
- Carol M. Mangione, MD, MSPH7,
- Theodore J. Thompson, MS8 and
- William H. Herman, MD, MPH1
- 1Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
- 2Internal Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- 3Division of Research, Kaiser Permanente, Oakland, CA
- 4Epidemiology, University of Michigan, Ann Arbor, MI
- 5Biostatistics, University of Michigan, Ann Arbor, MI
- 6Health Management and Policy, University of Michigan, Ann Arbor, MI
- 7Medicine, University of California, Los Angeles, CA
- 8Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
Abstract
Objective: To examine demographic, socioeconomic, and biological predictors of all-cause, cardiovascular, and noncardiovascular mortality in patients with diabetes.
Research Design and Methods: Survey, medical record, and administrative data were obtained from 8,733 participants in Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care. Data on deaths (n=791) and cause of death were obtained from the National Death Index (NDI) after 4 years. Predictors examined included age, sex, race, education, income, duration and treatment of diabetes, body mass index (BMI), smoking, microvascular and macrovascular complications, and comorbidities.
Results: Predictors of adjusted all-cause mortality included older age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05), male sex (HR 1.57, CI 1.35-1.83), lower income (<$15,000 vs. >$75,000 HR 1.82, CI 1.30-2.54; $15,000-$40,000 vs. >$75,000 HR 1.58, CI 1.15-2.17), longer duration of diabetes (≥9 years vs. <9 years HR 1.20, CI 1.02-1.41), lower BMI (<26 kg/m2 vs. 26-30 kg/m2 HR 1.43, CI 1.13-1.69), smoking (HR 1.44, CI 1.20-1.74), nephropathy (HR 1.46, CI 1.23-2.73), macrovascular disease (HR 1.46, CI 1.23-1.74), and greater Charlson index (≥2-3 vs. <1 HR 2.01, CI 1.04-3.90; ≥3 vs. <1 HR 4.38, CI 2.26-8.47). The predictors of cardiovascular and noncardiovascular mortality were different. Macrovascular disease predicted cardiovascular but not noncardiovascular mortality.
Conclusions: Among people with diabetes and access to medical care, older age, male gender, smoking, and renal disease are important predictors of mortality. Even within an insured population, socioeconomic circumstances are an important independent predictor of health.
Footnotes
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- Received February 13, 2007.
- Accepted April 15, 2007.
- Copyright © 2007 American Diabetes Association
