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

陈一佳; 苏健; 覃玉; 沈冲; 潘恩春; 俞浩; 陆艳; 张宁; 周金意; 武鸣

Abstract

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].Chinese journal of Epidemiology,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

Received:January 07, 2022

DOI：10.3760/cma.j.cn112338-20220107-00010

KeyWord: 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

English Key Word: Diabetes type 2 Socioeconomic status Mortality Latent class analysis Prospective study

FundProject: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）

Author Name	Affiliation	E-mail
Chen Yijia	Department of Non-communicable Chronic Disease Control, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
Su Jian	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Qin Yu	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Shen Chong	Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
Pan Enchun	Huai'an Center for Disease Control and Prevention, Huai'an 223001, China
Yu Hao	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Lu Yan	Department of Non-communicable Chronic Disease Control, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
Zhang Ning	Changshu Center for Disease Control and Prevention, Changshu 215500, China
Zhou Jinyi	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Wu Ming	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	jswuming@vip.sina.com

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Abstract:

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。

English Abstract:

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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