| 陈一佳,苏健,覃玉,沈冲,潘恩春,俞浩,陆艳,张宁,周金意,武鸣.基于潜在类别分析的社会经济地位与2型糖尿病患者死亡风险的前瞻性研究[J].中华流行病学杂志,2022,43(10):1619-1625 |
| 基于潜在类别分析的社会经济地位与2型糖尿病患者死亡风险的前瞻性研究 |
| A prospective cohort study on socioeconomic status and risk of all-cause mortality among patients with type 2 diabetes based on latent class analysis |
| 收稿日期:2022-01-07 出版日期:2022-10-18 |
| DOI：10.3760/cma.j.cn112338-20220107-00010 |
| 中文关键词: 糖尿病 2型 社会经济地位 死亡风险 潜在类别分析 前瞻性研究 |
| 英文关键词: Diabetes type 2 Socioeconomic status Mortality Latent class analysis Prospective study |
| 基金项目:江苏省领军人才与创新团队计划（K201105）；江苏省第五届“333工程”（BRA2020090）；江苏省卫生健康委员会2020年度医学科研项目（M2020085） |
| 作者 | 单位 | E-mail | | 陈一佳 | 南京市疾病预防控制中心慢性非传染病防制科, 南京 210003 | | | 苏健 | 江苏省疾病预防控制中心慢性非传染病防制所, 南京 210009 | | | 覃玉 | 江苏省疾病预防控制中心慢性非传染病防制所, 南京 210009 | | | 沈冲 | 南京医科大学公共卫生学院流行病与卫生统计学系, 南京 211166 | | | 潘恩春 | 淮安市疾病预防控制中心, 淮安 223001 | | | 俞浩 | 江苏省疾病预防控制中心慢性非传染病防制所, 南京 210009 | | | 陆艳 | 苏州市疾病预防控制中心慢性非传染病防制科, 苏州 215004 | | | 张宁 | 常熟市疾病预防控制中心, 常熟 215500 | | | 周金意 | 江苏省疾病预防控制中心慢性非传染病防制所, 南京 210009 | | | 武鸣 | 江苏省疾病预防控制中心慢性非传染病防制所, 南京 210009 | jswuming@vip.sina.com |
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| 中文摘要: |
| 目的 探讨2型糖尿病患者中社会经济地位（SES）和全死因死亡风险的关联。方法 以江苏省常熟市、淮安市清江浦区和淮安区纳入国家基本公共卫生服务管理的17 553名2型糖尿病患者作为观察队列。首先通过潜在类别分析，根据5项社会经济指标对患者的SES进行分类。然后利用Cox比例风险回归模型分性别计算不同SES人群随访期间的全死因死亡风险比（HR）及其95%CI，并按照年龄、城乡进行分层分析。结果 研究人群累计随访100 529.08人年，平均随访5.7年，随访期间糖尿病患者死亡1 829人。根据潜在类别模型拟合结果提示含3个潜在类别的模型最佳，故将人群SES分为低（8 256人，47.0%）、中（4 427人，25.2%）、高（4 870人，27.8%）3组。以高SES组为参照，调整混杂因素后，男、女性低SES组发生死亡的HR值（95%CI）分别为1.84（1.53~2.21）和1.41（1.51~1.72）。分层分析发现，男、女性低SES组在 < 60岁患者中发生死亡的HR值（95%CI）分别为1.99（1.12~2.95）和2.01（1.20~3.23），在≥60岁患者中为1.90（1.57~2.31）和1.40（1.13~1.73）；男、女性低SES组在城市患者中发生死亡的HR值（95%CI）分别为1.54（1.17~2.04）和1.27（1.02~1.59），在农村患者中为2.11（1.55~2.85）和2.64（1.17~3.35）。结论 低SES可增加2型糖尿病患者死亡风险，且这种负向关联在年轻人和农村人群中更显著。 |
| 英文摘要: |
| Objective To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes.Methods A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area.Results Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively.Conclusions Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations. |
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