title: Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis.
abstract: Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death.
  
  
  
  We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths.
  
  
  
  We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes.
  
  
  
  Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.|Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.|Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.
authors: Jose Miguel
authors: JM
authors: Baena-Díez
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: Judit
authors: J
authors: Peñafiel
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.|Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.
authors: Isaac
authors: I
authors: Subirana
authors: Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.|Univeristy of Girona, Girona, Spain.
authors: Rafel
authors: R
authors: Ramos
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: Roberto
authors: R
authors: Elosua
authors: San Jose Norte Health Centre, Zaragoza, Spain.
authors: Alejandro
authors: A
authors: Marín-Ibañez
authors: Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.|Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain.
authors: María Jesús
authors: MJ
authors: Guembe
authors: Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain.
authors: Fernando
authors: F
authors: Rigo
authors: Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.|Murcian Health Departament, Murcia, Spain.|University of Murcia, Murcia, Spain.|Murcian Institute of Biomedical Research, Murcia, Spain.
authors: María José
authors: MJ
authors: Tormo-Díaz
authors: Navarre Public Health Institute, Pamplona, Spain.|Research Network for Health Services in Chronic Disease, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.
authors: Conchi
authors: C
authors: Moreno-Iribas
authors: Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain.
authors: Joan Josep
authors: JJ
authors: Cabré
authors: Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain.
authors: Antonio
authors: A
authors: Segura
authors: Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
authors: Manel
authors: M
authors: García-Lareo
authors: Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.|Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain.
authors: Agustín
authors: A
authors: Gómez de la Cámara
authors: Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.|Primary Care Division, Department of Family Medicine, Primary Care Center San Pablo, Sevilla, Spain.
authors: José
authors: J
authors: Lapetra
authors: Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.
authors: Miquel
authors: M
authors: Quesada
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: Jaume
authors: J
authors: Marrugat
authors: Carlos III Health Institute, Madrid, Spain.
authors: Maria José
authors: MJ
authors: Medrano
authors: Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.
authors: Jesús
authors: J
authors: Berjón
authors: Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain.
authors: Guiem
authors: G
authors: Frontera
authors: Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.|Health and Consumers Department, Murcia Government, Murcia, Spain.
authors: Diana
authors: D
authors: Gavrila
authors: Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.|Navarre Public Health Institute, Pamplona, Spain.|Navarra Health Research Institute, Pamplona, Spain.
authors: Aurelio
authors: A
authors: Barricarte
authors: Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain.
authors: Josep
authors: J
authors: Basora
authors: Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain.
authors: Jose María
authors: JM
authors: García
authors: Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
authors: Natalia C
authors: NC
authors: Pavone
authors: Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.|Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain.
authors: David
authors: D
authors: Lora-Pablos
authors: Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.|Diabetes Strategy, Andalusia Health Service, Seville, Spain.
authors: Eduardo
authors: E
authors: Mayoral
authors: Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.|Consortium for Biomedical Research in Diabetes and Associated Metabolic Diseases, Madrid, Spain.
authors: Josep
authors: J
authors: Franch
authors: Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.
authors: Manel
authors: M
authors: Mata
authors: Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors: Conxa
authors: C
authors: Castell
authors: Department of Urology, Hospital del Mar, Barcelona, Spain.
authors: Albert
authors: A
authors: Frances
authors: REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain mgrau@imim.es.|University of Barcelona, Barcelona, Spain.
authors: María
authors: M
authors: Grau
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001786:Blood Glucose