Diabetes and the risk of infection-related mortality in the U.S.
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.


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.
Bertoni
A G
AG
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Saydah
S
S
Brancati
F L
FL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015992:Body Mass Index; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007239:Infections / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D002784:Cholesterol