title: Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis.
abstract: BACKGROUND
  Studies have suggested sex differences in the mortality rate associated with type 1 diabetes. We did a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes.
  
  
  METHODS
  We systematically searched PubMed for studies published between Jan 1, 1966, and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. We used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes.
  
  
  RESULTS
  Data from 26 studies including 214 114 individuals and 15 273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·37 (95% CI 1·21-1·56), for incident stroke 1·37 (1·03-1·81), for fatal renal disease 1·44 (1·02-2·05), and for fatal cardiovascular diseases 1·86 (1·62-2·15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2·54 (95% CI 1·80-3·60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide.
  
  
  CONCLUSIONS
  Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes.
  
  
  BACKGROUND
  None.
authors: School of Public Health, University of Queensland, Brisbane, QLD, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia. Electronic address: r.huxley@uq.edu.au.
authors: Rachel R
authors: RR
authors: Huxley
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors: Sanne A E
authors: SA
authors: Peters
authors: School of Public Health, University of Queensland, Brisbane, QLD, Australia.
authors: Gita D
authors: GD
authors: Mishra
authors: The George Institute for Global Health, University of Sydney, Sydney, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors: Mark
authors: M
authors: Woodward
mesh_terms: D000704:Analysis of Variance; D048909:Diabetes Complications / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000266:history / Q000401:mortality* / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D012727:Sex Characteristics