Excess Risk of Mortality and Complications Associated with Newly Diagnosed Cases of Diabetes in Ontario, Canada

  • Ron goeree
    Correspondence
    Ron Goeree, PATH Research Institute 25 Main Street West, Suite 2000, Hamilton, Ontario, Canada, L8P 1H1 Telephone: (905) 523–7284 ext. 5266, Fax: (905) 522–0568
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • Morgan E. lim
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • Robert Hopkins
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • gordon blackhouse
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • Jean-Eric tarride
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • feng xie
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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  • daria o'Reilly
    Affiliations
    programs for assessment of technology in Health (patH) Research institute, st. Joseph's Hospital, Hamilton, ontario, canada

    department of clinical Epidemiology and biostatistics, McMaster University, Hamilton, ontario, canada
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      ABSTRACT

      OBJECTIVES

      1) To estimate the excess risk of death and complications associated with diabetes in adults aged 35 years and older and newly diagnosed with diabetes compared to those without diabetes; and 2) to calculate cumulative relative risks for death and complications associated with diabetes in newly diagnosed cases of diabetes in adults aged 35 and over.

      METHODS

      Newly diagnosed type 1 and 2 diabetes cases aged 35 and over were identified from the Ontario Diabetes Database and matched 1:2 using propensity scores with controls (non-diabetes cases). Using linked administrative databases in the province, data on death and the following complications were recorded: myocardial infarction, stroke, angina, heart failure, blindness, amputation, nephropathy and cataract. Kaplan-Meier curves were calculated to estimate the probability of being event-free for those with and without diabetes for up to 10 years of follow-up.

      RESULTS

      A total of 610 852 patients aged 35 and over with diabetes were matched with 1 221 704 patients without diabetes. For those with diabetes vs. those without, there was a statistically significant increased relative risk at 10 years for death (1.42, 95% CI 1.42–1.42), myocardial infarction (2.09, 95% CI 2.09–2.10), stroke (1.88, 95% CI 1.88–1.88), angina (1.53, 95% CI 1.53–1.53), heart failure (2.52, 95% CI 2.53–2.52), amputation (6.82, 95% CI 6.82–6.82), nephropathy (2.90, 95% CI 2.90–2.90), blindness (1.21, 95% CI 1.21–1.22) and cataract (1.33, 95% CI 1.32–1.33).

      CONCLUSIONS

      The information provided in this study can be used to target clinical practice at complications typically associated with diabetes and can be used as inputs for long-term disease and economic modelling.

      RÉSUMÉ

      OBJECTIFS

      1) Comparer des personnes de 35 ans et plus chez qui un diabète vient d'être diagnostiqué à des personnes de 35 ans et plus exemptes de diabète du point de vue du risque excédentaire de décès et de complications associées au diabète; et 2) calculer les risques relatifs cumulatifs de décès et de complications associées au diabète des personnes de 35 ans et plus chez qui un diabète vient d'être diagnostiqué.

      MÉThODES

      Des personnes de 35 ans et plus chez qui un diabète de type 1 ou 2 venait d'être diagnostiqué ont été repérées dans la Ontario Diabetes Database et appariées à des témoins (personnes exemptes de diabète) dans un rapport 1:2 au moyen de scores de propension. Dans des bases de données administratives provinciales reliées entre elles, on a recueilli les données sur les décès et les complications sui-vantes : infarctus du myocarde, accident vasculaire cérébral, angine de poitrine, insuffisance cardiaque, cécité, amputation, néphropathie et cataractes. Des courbes de Kaplan-Meier ont été calculées pour estimer la probabilité d'absence d'événements au cours d'un suivi de jusqu'à dix ans chez les personnes atteintes ou exemptes de diabète.

      RÉSULTATS

      Au total, 610 852 personnes de 35 ans et plus atteintes de diabète ont été appariées à 1 221 704 personnes exemptes de diabète. Par rapport aux per-sonnes exemptes de diabète, il y avait chez celles atteintes de diabète une augmentation statistiquement significative du risque relatif de décès à dix ans (1,42; IC de 95 % : 1,42 à 1,42), d'infarctus du myocarde (2,09; IC de 95 % : 2,09 à 2,10), d'accident vasculaire cérébral (1,88; IC de 95 % : 1,87 à 1,88), d'angine de poitrine (1,53; IC de 95 % : 1,53 à 1,53), d'insuffisance cardiaque (2,52; IC de 95 % : 2,53 à 2,52), d'amputation (6,82; IC de 95 % : 6,82 à 6,82), de néphropathie (2,90; IC de 95 % : 2,90 à 2,90), de cécité (1,21; IC de 95 % : 1,21 à 1,22) et de cataractes (1,33; IC de 95 % : 1,32 à 1,33).

      CONCLUSIONS

      Les données de cette étude peuvent être utilisées pour axer les interventions cliniques sur les complications typiquement associées au diabète et servir d'intrants pour la modélisation à long terme de la maladie et économique.

      KEywORDS

      MOTS CLÉS

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