Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants

Jae Jeong Yang; Danxia Yu; Wanqing Wen; Eiko Saito; Shafiur Rahman; Xiao Ou Shu; Yu Chen; Prakash C. Gupta; Dongfeng Gu; Shoichiro Tsugane; Yong Bing Xiang; Yu Tang Gao; Jian Min Yuan; Akiko Tamakoshi; Fujiko Irie; Atsuko Sadakane; Yasutake Tomata; Seiki Kanemura; Ichiro Tsuji; Keitaro Matsuo; Chisato Nagata; Chien Jen Chen; Woon Puay Koh; Myung Hee Shin; Sue K. Park; Pei Ei Wu; You Lin Qiao; Mangesh S. Pednekar; Jiang He; Norie Sawada; Hong Lan Li; Jing Gao; Hui Cai; Renwei Wang; Toshimi Sairenchi; Eric Grant; Yumi Sugawara; Shu Zhang; Hidemi Ito; Keiko Wada; Chen Yang Shen; Wen Harn Pan; Yoon Ok Ahn; San Lin You; Jin Hu Fan; Keun Young Yoo; Habibul Ashan; Kee Seng Chia; Paolo Boffetta; Manami Inoue; Daehee Kang; John D. Potter; Wei Zheng

doi:10.1001/jamanetworkopen.2019.2696

Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants

Jae Jeong Yang, Danxia Yu, Wanqing Wen, Eiko Saito, Shafiur Rahman, Xiao Ou Shu, Yu Chen, Prakash C. Gupta, Dongfeng Gu, Shoichiro Tsugane, Yong Bing Xiang, Yu Tang Gao, Jian Min Yuan, Akiko Tamakoshi, Fujiko Irie, Atsuko Sadakane, Yasutake Tomata, Seiki Kanemura, Ichiro Tsuji, Keitaro MatsuoChisato Nagata, Chien Jen Chen, Woon Puay Koh, Myung Hee Shin, Sue K. Park, Pei Ei Wu, You Lin Qiao, Mangesh S. Pednekar, Jiang He, Norie Sawada, Hong Lan Li, Jing Gao, Hui Cai, Renwei Wang, Toshimi Sairenchi, Eric Grant, Yumi Sugawara, Shu Zhang, Hidemi Ito, Keiko Wada, Chen Yang Shen, Wen Harn Pan, Yoon Ok Ahn, San Lin You, Jin Hu Fan, Keun Young Yoo, Habibul Ashan, Kee Seng Chia, Paolo Boffetta, Manami Inoue, Daehee Kang, John D. Potter, Wei Zheng

Urban Initiative

Research output: Contribution to journal › Article › peer-review

Abstract

Importance: Asia is home to the largest diabetic populations in the world. However, limited studies have quantified the association of diabetes with all-cause and cause-specific mortality in Asian populations.

Objectives: To evaluate the association of diabetes with all-cause and cause-specific mortality in Asia and to investigate potential effect modifications of the diabetes-mortality associations by participants' age, sex, education level, body mass index, and smoking status.

Design, Setting, and Participants: This pooled analysis incorporated individual participant data from 22 prospective cohort studies of the Asia Cohort Consortium conducted between 1963 and 2006. A total of 1 002 551 Asian individuals (from mainland China, Japan, South Korea, Singapore, Taiwan, India, and Bangladesh) were followed up for more than 3 years. Cohort-specific hazard ratios and 95% confidence intervals for all-cause and cause-specific mortality were estimated using Cox regression models and then pooled using random-effects meta-analysis. Analysis was conducted between January 10, 2018, and August 31, 2018.

Exposures: Doctor-diagnosed diabetes, age, sex, education level, body mass index, and smoking status.

Main Outcomes and Measures: All-cause and cause-specific mortality.

Results: Of 1 002 551 participants (518 537 [51.7%] female; median [range] age, 54.0 [30.0-98.0] years), 148 868 deaths were ascertained during a median (range) follow-up of 12.6 (3.0-38.9) years. The overall prevalence of diabetes reported at baseline was 4.8% for men and 3.6% for women. Patients with diabetes had a 1.89-fold risk of all-cause death compared with patients without diabetes (hazard ratio [HR], 1.89; 95% CI, 1.74-2.04), with the highest relative risk of death due to diabetes itself (HR, 22.8; 95% CI, 18.5-28.1), followed by renal disease (HR, 3.08; 95% CI, 2.50-3.78), coronary heart disease (HR, 2.57; 95% CI, 2.19-3.02), and ischemic stroke (HR, 2.15; 95% CI, 1.85-2.51). The adverse diabetes-mortality associations were more evident among women (HR, 2.09; 95% CI, 1.89-2.32) than among men (HR, 1.74; 95% CI, 1.62-1.88) (P for interaction < .001) and more evident among adults aged 30 to 49 years (HR, 2.43; 95% CI, 2.08-2.84) than among adults aged 70 years and older (HR, 1.51; 95% CI, 1.40-1.62) (P for interaction < .001). A similar pattern of association was found between diabetes and cause-specific mortality, with significant variations noted by sex and age.

Conclusions and Relevance: This study found that diabetes was associated with increased risk of death from several diseases among Asian populations. Development and implementation of diabetes management programs are urgently needed to reduce the burden of diabetes in Asia.

Original language	English (US)
Article number	e192696
Journal	JAMA network open
Volume	2
Issue number	4
DOIs	https://doi.org/10.1001/jamanetworkopen.2019.2696
State	Published - Apr 2019

Keywords

Adult
Aged
Asia/epidemiology
Cause of Death
Diabetes Mellitus/mortality
Female
Humans
Male
Middle Aged
Prevalence
Proportional Hazards Models
Prospective Studies
Risk Factors

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10.1001/jamanetworkopen.2019.2696

Cite this

Yang, J. J., Yu, D., Wen, W., Saito, E., Rahman, S., Shu, X. O., Chen, Y., Gupta, P. C., Gu, D., Tsugane, S., Xiang, Y. B., Gao, Y. T., Yuan, J. M., Tamakoshi, A., Irie, F., Sadakane, A., Tomata, Y., Kanemura, S., Tsuji, I., ... Zheng, W. (2019). Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants. JAMA network open, 2(4), Article e192696. https://doi.org/10.1001/jamanetworkopen.2019.2696

Yang, JJ, Yu, D, Wen, W, Saito, E, Rahman, S, Shu, XO, Chen, Y, Gupta, PC, Gu, D, Tsugane, S, Xiang, YB, Gao, YT, Yuan, JM, Tamakoshi, A, Irie, F, Sadakane, A, Tomata, Y, Kanemura, S, Tsuji, I, Matsuo, K, Nagata, C, Chen, CJ, Koh, WP, Shin, MH, Park, SK, Wu, PE, Qiao, YL, Pednekar, MS, He, J, Sawada, N, Li, HL, Gao, J, Cai, H, Wang, R, Sairenchi, T, Grant, E, Sugawara, Y, Zhang, S, Ito, H, Wada, K, Shen, CY, Pan, WH, Ahn, YO, You, SL, Fan, JH, Yoo, KY, Ashan, H, Chia, KS, Boffetta, P, Inoue, M, Kang, D, Potter, JD & Zheng, W 2019, 'Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants', JAMA network open, vol. 2, no. 4, e192696. https://doi.org/10.1001/jamanetworkopen.2019.2696

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title = "Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants",

abstract = "Importance: Asia is home to the largest diabetic populations in the world. However, limited studies have quantified the association of diabetes with all-cause and cause-specific mortality in Asian populations.Objectives: To evaluate the association of diabetes with all-cause and cause-specific mortality in Asia and to investigate potential effect modifications of the diabetes-mortality associations by participants' age, sex, education level, body mass index, and smoking status.Design, Setting, and Participants: This pooled analysis incorporated individual participant data from 22 prospective cohort studies of the Asia Cohort Consortium conducted between 1963 and 2006. A total of 1 002 551 Asian individuals (from mainland China, Japan, South Korea, Singapore, Taiwan, India, and Bangladesh) were followed up for more than 3 years. Cohort-specific hazard ratios and 95% confidence intervals for all-cause and cause-specific mortality were estimated using Cox regression models and then pooled using random-effects meta-analysis. Analysis was conducted between January 10, 2018, and August 31, 2018.Exposures: Doctor-diagnosed diabetes, age, sex, education level, body mass index, and smoking status.Main Outcomes and Measures: All-cause and cause-specific mortality.Results: Of 1 002 551 participants (518 537 [51.7%] female; median [range] age, 54.0 [30.0-98.0] years), 148 868 deaths were ascertained during a median (range) follow-up of 12.6 (3.0-38.9) years. The overall prevalence of diabetes reported at baseline was 4.8% for men and 3.6% for women. Patients with diabetes had a 1.89-fold risk of all-cause death compared with patients without diabetes (hazard ratio [HR], 1.89; 95% CI, 1.74-2.04), with the highest relative risk of death due to diabetes itself (HR, 22.8; 95% CI, 18.5-28.1), followed by renal disease (HR, 3.08; 95% CI, 2.50-3.78), coronary heart disease (HR, 2.57; 95% CI, 2.19-3.02), and ischemic stroke (HR, 2.15; 95% CI, 1.85-2.51). The adverse diabetes-mortality associations were more evident among women (HR, 2.09; 95% CI, 1.89-2.32) than among men (HR, 1.74; 95% CI, 1.62-1.88) (P for interaction < .001) and more evident among adults aged 30 to 49 years (HR, 2.43; 95% CI, 2.08-2.84) than among adults aged 70 years and older (HR, 1.51; 95% CI, 1.40-1.62) (P for interaction < .001). A similar pattern of association was found between diabetes and cause-specific mortality, with significant variations noted by sex and age.Conclusions and Relevance: This study found that diabetes was associated with increased risk of death from several diseases among Asian populations. Development and implementation of diabetes management programs are urgently needed to reduce the burden of diabetes in Asia.",

keywords = "Adult, Aged, Asia/epidemiology, Cause of Death, Diabetes Mellitus/mortality, Female, Humans, Male, Middle Aged, Prevalence, Proportional Hazards Models, Prospective Studies, Risk Factors",

author = "Yang, {Jae Jeong} and Danxia Yu and Wanqing Wen and Eiko Saito and Shafiur Rahman and Shu, {Xiao Ou} and Yu Chen and Gupta, {Prakash C.} and Dongfeng Gu and Shoichiro Tsugane and Xiang, {Yong Bing} and Gao, {Yu Tang} and Yuan, {Jian Min} and Akiko Tamakoshi and Fujiko Irie and Atsuko Sadakane and Yasutake Tomata and Seiki Kanemura and Ichiro Tsuji and Keitaro Matsuo and Chisato Nagata and Chen, {Chien Jen} and Koh, {Woon Puay} and Shin, {Myung Hee} and Park, {Sue K.} and Wu, {Pei Ei} and Qiao, {You Lin} and Pednekar, {Mangesh S.} and Jiang He and Norie Sawada and Li, {Hong Lan} and Jing Gao and Hui Cai and Renwei Wang and Toshimi Sairenchi and Eric Grant and Yumi Sugawara and Shu Zhang and Hidemi Ito and Keiko Wada and Shen, {Chen Yang} and Pan, {Wen Harn} and Ahn, {Yoon Ok} and You, {San Lin} and Fan, {Jin Hu} and Yoo, {Keun Young} and Habibul Ashan and Chia, {Kee Seng} and Paolo Boffetta and Manami Inoue and Daehee Kang and Potter, {John D.} and Wei Zheng",

year = "2019",

month = apr,

doi = "10.1001/jamanetworkopen.2019.2696",

language = "English (US)",

volume = "2",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "4",

}

TY - JOUR

T1 - Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia

T2 - A Pooled Analysis of More Than 1 Million Participants

AU - Yang, Jae Jeong

AU - Yu, Danxia

AU - Wen, Wanqing

AU - Saito, Eiko

AU - Rahman, Shafiur

AU - Shu, Xiao Ou

AU - Chen, Yu

AU - Gupta, Prakash C.

AU - Gu, Dongfeng

AU - Tsugane, Shoichiro

AU - Xiang, Yong Bing

AU - Gao, Yu Tang

AU - Yuan, Jian Min

AU - Tamakoshi, Akiko

AU - Irie, Fujiko

AU - Sadakane, Atsuko

AU - Tomata, Yasutake

AU - Kanemura, Seiki

AU - Tsuji, Ichiro

AU - Matsuo, Keitaro

AU - Nagata, Chisato

AU - Chen, Chien Jen

AU - Koh, Woon Puay

AU - Shin, Myung Hee

AU - Park, Sue K.

AU - Wu, Pei Ei

AU - Qiao, You Lin

AU - Pednekar, Mangesh S.

AU - He, Jiang

AU - Sawada, Norie

AU - Li, Hong Lan

AU - Gao, Jing

AU - Cai, Hui

AU - Wang, Renwei

AU - Sairenchi, Toshimi

AU - Grant, Eric

AU - Sugawara, Yumi

AU - Zhang, Shu

AU - Ito, Hidemi

AU - Wada, Keiko

AU - Shen, Chen Yang

AU - Pan, Wen Harn

AU - Ahn, Yoon Ok

AU - You, San Lin

AU - Fan, Jin Hu

AU - Yoo, Keun Young

AU - Ashan, Habibul

AU - Chia, Kee Seng

AU - Boffetta, Paolo

AU - Inoue, Manami

AU - Kang, Daehee

AU - Potter, John D.

AU - Zheng, Wei

PY - 2019/4

Y1 - 2019/4

N2 - Importance: Asia is home to the largest diabetic populations in the world. However, limited studies have quantified the association of diabetes with all-cause and cause-specific mortality in Asian populations.Objectives: To evaluate the association of diabetes with all-cause and cause-specific mortality in Asia and to investigate potential effect modifications of the diabetes-mortality associations by participants' age, sex, education level, body mass index, and smoking status.Design, Setting, and Participants: This pooled analysis incorporated individual participant data from 22 prospective cohort studies of the Asia Cohort Consortium conducted between 1963 and 2006. A total of 1 002 551 Asian individuals (from mainland China, Japan, South Korea, Singapore, Taiwan, India, and Bangladesh) were followed up for more than 3 years. Cohort-specific hazard ratios and 95% confidence intervals for all-cause and cause-specific mortality were estimated using Cox regression models and then pooled using random-effects meta-analysis. Analysis was conducted between January 10, 2018, and August 31, 2018.Exposures: Doctor-diagnosed diabetes, age, sex, education level, body mass index, and smoking status.Main Outcomes and Measures: All-cause and cause-specific mortality.Results: Of 1 002 551 participants (518 537 [51.7%] female; median [range] age, 54.0 [30.0-98.0] years), 148 868 deaths were ascertained during a median (range) follow-up of 12.6 (3.0-38.9) years. The overall prevalence of diabetes reported at baseline was 4.8% for men and 3.6% for women. Patients with diabetes had a 1.89-fold risk of all-cause death compared with patients without diabetes (hazard ratio [HR], 1.89; 95% CI, 1.74-2.04), with the highest relative risk of death due to diabetes itself (HR, 22.8; 95% CI, 18.5-28.1), followed by renal disease (HR, 3.08; 95% CI, 2.50-3.78), coronary heart disease (HR, 2.57; 95% CI, 2.19-3.02), and ischemic stroke (HR, 2.15; 95% CI, 1.85-2.51). The adverse diabetes-mortality associations were more evident among women (HR, 2.09; 95% CI, 1.89-2.32) than among men (HR, 1.74; 95% CI, 1.62-1.88) (P for interaction < .001) and more evident among adults aged 30 to 49 years (HR, 2.43; 95% CI, 2.08-2.84) than among adults aged 70 years and older (HR, 1.51; 95% CI, 1.40-1.62) (P for interaction < .001). A similar pattern of association was found between diabetes and cause-specific mortality, with significant variations noted by sex and age.Conclusions and Relevance: This study found that diabetes was associated with increased risk of death from several diseases among Asian populations. Development and implementation of diabetes management programs are urgently needed to reduce the burden of diabetes in Asia.

AB - Importance: Asia is home to the largest diabetic populations in the world. However, limited studies have quantified the association of diabetes with all-cause and cause-specific mortality in Asian populations.Objectives: To evaluate the association of diabetes with all-cause and cause-specific mortality in Asia and to investigate potential effect modifications of the diabetes-mortality associations by participants' age, sex, education level, body mass index, and smoking status.Design, Setting, and Participants: This pooled analysis incorporated individual participant data from 22 prospective cohort studies of the Asia Cohort Consortium conducted between 1963 and 2006. A total of 1 002 551 Asian individuals (from mainland China, Japan, South Korea, Singapore, Taiwan, India, and Bangladesh) were followed up for more than 3 years. Cohort-specific hazard ratios and 95% confidence intervals for all-cause and cause-specific mortality were estimated using Cox regression models and then pooled using random-effects meta-analysis. Analysis was conducted between January 10, 2018, and August 31, 2018.Exposures: Doctor-diagnosed diabetes, age, sex, education level, body mass index, and smoking status.Main Outcomes and Measures: All-cause and cause-specific mortality.Results: Of 1 002 551 participants (518 537 [51.7%] female; median [range] age, 54.0 [30.0-98.0] years), 148 868 deaths were ascertained during a median (range) follow-up of 12.6 (3.0-38.9) years. The overall prevalence of diabetes reported at baseline was 4.8% for men and 3.6% for women. Patients with diabetes had a 1.89-fold risk of all-cause death compared with patients without diabetes (hazard ratio [HR], 1.89; 95% CI, 1.74-2.04), with the highest relative risk of death due to diabetes itself (HR, 22.8; 95% CI, 18.5-28.1), followed by renal disease (HR, 3.08; 95% CI, 2.50-3.78), coronary heart disease (HR, 2.57; 95% CI, 2.19-3.02), and ischemic stroke (HR, 2.15; 95% CI, 1.85-2.51). The adverse diabetes-mortality associations were more evident among women (HR, 2.09; 95% CI, 1.89-2.32) than among men (HR, 1.74; 95% CI, 1.62-1.88) (P for interaction < .001) and more evident among adults aged 30 to 49 years (HR, 2.43; 95% CI, 2.08-2.84) than among adults aged 70 years and older (HR, 1.51; 95% CI, 1.40-1.62) (P for interaction < .001). A similar pattern of association was found between diabetes and cause-specific mortality, with significant variations noted by sex and age.Conclusions and Relevance: This study found that diabetes was associated with increased risk of death from several diseases among Asian populations. Development and implementation of diabetes management programs are urgently needed to reduce the burden of diabetes in Asia.

KW - Adult

KW - Aged

KW - Asia/epidemiology

KW - Cause of Death

KW - Diabetes Mellitus/mortality

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Risk Factors

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U2 - 10.1001/jamanetworkopen.2019.2696

DO - 10.1001/jamanetworkopen.2019.2696

M3 - Article

C2 - 31002328

AN - SCOPUS:85065014985

SN - 2574-3805

VL - 2

JO - JAMA network open

JF - JAMA network open

IS - 4

M1 - e192696

ER -

Association of Diabetes with All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants

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