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Risk Factors for Mortality Among Patients With Diabetes

The Translating Research Into Action for Diabetes (TRIAD) Study

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
² Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
³ Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
⁴ Division of Research, Kaiser Permanente, Oakland, California
⁵ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
⁶ Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
⁷ Department of Medicine, University of California, Los Angeles, California
⁸ Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia

Address correspondence and reprint requests to Laura N. McEwen, PhD, Internal Medicine/Metabolism, Endocrinology, and Diabetes, 1500 East Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109. E-mail: lmattei{at}med.umich.edu

OBJECTIVE— We sought 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 the Translating Research Into Action for Diabetes Study, 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 after 4 years. Predictors examined included age, sex, race, education, income, duration, and treatment of diabetes, BMI, smoking, microvascular and macrovascular complications, and comorbidities.

RESULTS— Predictors of adjusted all-cause mortality included older age (hazard ratio [HR] 1.04 [95% CI 1.03–1.05]), male sex (1.57 [1.35–1.83]), lower income (<$15,000 vs. >$75,000, HR 1.82 [1.30–2.54]; $15,000–$40,000 vs. >$75,000, HR 1.58 [1.15–2.17]), longer duration of diabetes (9 years vs. <9 years, HR 1.20 [1.02–1.41]), lower BMI (<26 vs. 26–30 kg/m², HR 1.43 [1.13–1.69]), smoking (1.44 [1.20–1.74]), nephropathy (1.46 [1.23–2.73]), macrovascular disease (1.46 [1.23–1.74]), and greater Charlson index (2–3 vs. <1, HR 2.01 [1.04–3.90]; 3 vs. <1, HR 4.38 [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 sex, smoking, and renal disease are important predictors of mortality. Even within an insured population, socioeconomic circumstance is an important independent predictor of health.

Abbreviations: NDI, National Death Index • TRIAD, Translating Research Into Action for Diabetes

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