在中国，最近几十年的糖尿病患病率大幅增加，但是目前尚无糖尿病对死亡率额外影响的可靠估计。
2017年1月17日，《美国医学会杂志》正式发表英国牛津大学、中国医学科学院、青岛市疾病预防控制中心、河南省疾病预防控制中心、国家食品安全风险评估中心、北京大学公共卫生学院的研究报告，评估了与糖尿病相关额外死亡率绝对值，并估计中国农村和城市地区的糖尿病相关额外死亡率绝对值。
该研究对中国10个（5个农村和5个城市）地区的512869位30～79岁成人（其中女性302618位，占59%，平均年龄51.5±10.7岁）进行为期7年的全国前瞻研究，2004年6月～2008年7月入组并随访至2014年，在入组时记录糖尿病（既往确诊或通过筛查检出），通过原有死亡登记处收集全因死亡率和特定原因死亡率，使用Cox回归估计校正死亡率比值比，比较糖尿病个体与入组时无糖尿病的个体。
结果发现，糖尿病总患病率为5.9%（30280例），农村地区、城市地区、男性、女性的糖尿病患病率分别为4.1%、8.1%、5.8%、6.1%，既往确诊、通过筛查检出的糖尿病患病率分别为3.1%、2.8%。
在每年随访的364万人中，有24909例死亡，其中糖尿病患者有3384例。与无糖尿病的成人相比，糖尿病患者的全因死亡风险显著增加2倍，农村地区、城市地区分别增加2.17、1.83倍。
糖尿病患者的缺血性心脏病、中风、慢性肝病、感染、胰腺癌、女性乳腺癌、女性生殖系统癌症死亡风险分别增加2.40、1.98、2.32、2.29、1.54、1.84、1.84、1.81倍。农村地区、城市地区的慢性肾病死亡风险分别增加18.69、6.83倍。在糖尿病患者中，确定或可能的糖尿病酮症酸中毒或昏迷所致死亡率为10%（农村16%，城市4%）。
因此，在中国成人中，糖尿病与一系列心血管和非心血管疾病的死亡率增加有相关性。虽然糖尿病在城市地区更常见，但是与农村地区的死亡率更高有相关性。
JAMA. 2017 Jan 17;317(3):280-289.
Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.
Bragg F, Holmes MV, Iona A, Guo Y, Du H, Chen Y, Bian Z, Yang L, Herrington W, Bennett D, Turnbull I, Liu Y, Feng S, Chen J, Clarke R, Collins R, Peto R, Li L, Chen Z; China Kadoorie Biobank Collaborative Group..
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield; University of Oxford, Oxford, England; Chinese Academy of Medical Sciences, Beijing, China; Qingdao Center for Disease Control and Prevention, Qingdao, China; Henan Provincial Center for Disease Control and Prevention, Henan, China; National Center for Food Safety Risk Assessment, Beijing, China; School of Public Health, Peking University, Beijing, China.
IMPORTANCE: In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes.
OBJECTIVES: To assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China.
DESIGN, SETTING, AND PARTICIPANTS: A 7-year nationwide prospective study of 512,869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014.
EXPOSURES: Diabetes (previously diagnosed or detected by screening) recorded at baseline.
MAIN OUTCOMES AND MEASURES: All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline.
RESULTS: Among the 512,869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n = 302,618) were women, and 5.9% (n = 30,280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24,909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100,000; adjusted RR, 2.00 [95% CI, 1.93-2.08]), which was higher in rural areas than in urban areas (rural RR, 2.17 [95% CI, 2.07-2.29]; urban RR, 1.83 [95% CI, 1.73-1.94]). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 [95% CI, 2.19-2.63]), stroke (4444 deaths; RR, 1.98 [95% CI, 1.81-2.17]), chronic liver disease (481 deaths; RR, 2.32 [95% CI, 1.76-3.06]), infections (425 deaths; RR, 2.29 [95% CI, 1.76-2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95% CI, 1.28-1.86]), pancreas (357 deaths; RR, 1.84 [95% CI, 1.35-2.51]), female breast (217 deaths; RR, 1.84 [95% CI, 1.24-2.74]), and female reproductive system (210 deaths; RR, 1.81 [95% CI, 1.20-2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 [95% CI, 14.22-24.57]) than in urban areas (6.83 [95% CI, 4.73-9.88]). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths).
CONCLUSIONS AND RELEVANCE: Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.
PMID: 28114552
DOI: 10.1001/jama.2016.19720
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