Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes – a 10‐year cohort study of older people with and without diabetes. Issue 3 (28th May 2016)

• Record Type: Journal Article
• Authors: Forbes, A.; Murrells, T.; Sinclair, A. J.
• Is Part Of: Diabetic medicine. Volume 34:Issue 3(2017)
• Page Start: 387
• Page End: 395
• Publication Date: 2016-05-28
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13132
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To compare all‐cause mortality in older people with or without diabetes and consider the associated risk of comorbidity and polypharmacy. Methods: A 10‐year cohort study using data from the Health Innovation Network database (2003–2013) comparing mortality in people aged ≥ 70 years with diabetes (DM cohort) ( n = 35 717) and without diabetes (No DM cohort) ( n = 307 918). Results: The mean age of the DM cohort was 78.1 ± 5.8 years vs. 79.0 ± 6.3 years in the No DM cohort. Mean diabetes duration was 8.2 ± 8.1 years, and 30% had diabetes for > 10 years. The DM cohort had a greater comorbidity load and people in this cohort were prescribed more therapies than the No DM cohort. The 5‐ and 10‐year survival rates were lower in the DM cohort at 64% and 39%, respectively, compared with 72% and 50% in the No DM cohort. The excess mortality in the DM cohort was greatest in those aged < 75 years with longer duration diabetes, the relative hazard for mortality was higher in females. Although comorbidity and polypharmacy were associated with increased mortality risk in the DM cohort, this risk was lower compared with the No DM cohort. The hazard ratios (95% confidence interval) for comorbidities > 4 and medicines ≥ 7 were 1.29 (1.19 to 1.41) and 1.34 (1.25 to 1.43) in the DM cohort and 1.63 (1.57 to 1.70) and 1.48 (1.40 to 1.56) in the No DM cohort, respectively. Conclusions: There is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure. What's new?: Older people with diabetes experience excess mortality compared with those without diabetes. Comorbidity and polypharmacy increase mortality risk for older people with diabetes, but they do not explain excess mortality. Mortality hazard is significantly greater for younger older people (70–75 years) with longer disease duration. Gender is important in mortality for older people with diabetes, although males experience higher levels of absolute mortality, the relative risk is much greater for females. Heart failure is a standout risk factor for mortality risk in older people with diabetes.