Affiliation:
1. Department of Medicine, School of Medicine
2. Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland
Abstract
OBJECTIVE—To determine whether diabetes predicts infection-related mortality and to clarify the extent to which this relationship is mediated by comorbid conditions that may themselves increase risk of infection.
RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using the Second National Health and Nutrition Examination Survey Mortality Study of 9,208 adults aged 30–74 years in 1976–1980. We defined demographic variables, diabetes, cardiovascular disease (CVD), and smoking by self-report; BMI, blood pressure, and serum cholesterol from baseline examination; and cause-specific mortality from death certificates.
RESULTS—Over 12–16 years of follow-up, 36 infection-related deaths occurred among 533 adults with diabetes vs. 265 deaths in 8,675 adults without diabetes (4.7 vs. 1.5 per 1,000 person-years, P < 0.001). Diabetes (RR 2.0, 95% CI 1.2–3.2) and congestive heart failure (2.8, 1.6–5.1) were independent predictors of infection-related mortality after simultaneous adjustment for age, sex, race, poverty status, smoking, BMI, and hypertension. After subdividing infection-related deaths into those with (n = 145) and without (n = 156) concurrent cardiovascular diagnoses at the time of death, diabetic adults were at risk for infection-related death with CVD (3.0, 1.8–5.0) but not without CVD (1.0, 0.5–2.2).
CONCLUSIONS—These nationally representative data suggest that diabetic adults are at greater risk for infection-related mortality, and the excess risk may be mediated by CVD.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference32 articles.
1. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW: Infections in patients with diabetes mellitus. N Engl J Med 341: 1906–1912, 1999
2. Boyko EJ, Lipsky BA: Infection and diabetes. In Diabetes in America. Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennet PH, Eds. Washington, DC, National Institutes of Health, 1995, p. 485–499
3. Sentochnik DE, Eliopoulos GM: Infection and diabetes. In Joslin’s Diabetes Mellitus. Kahn CR, Weir GC, Eds. Philadelphia, Lea & Febiger, 1994, p. 867–888
4. McMahon MM, Bistrian BR: Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9:1–9, 1995
5. Stallone DD: The influence of obesity and its treatment on the immune system. Nutr Rev 52:37–50, 1994
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