title: Survival of macrovascular disease, chronic kidney disease, chronic respiratory disease, cancer and smoking in patients with type 2 diabetes: BioBank Japan cohort.
abstract: BACKGROUND
  The number of patients with diabetes is increasing worldwide. Macrovascular disease, chronic kidney disease, chronic respiratory disease, cancer and smoking frequently accompany type 2 diabetes. Few data are available related to mortality of Asians with diabetes associated with these serious comorbidities. The present study aimed to quantify the excess mortality risks of type 2 diabetic patients with comorbidities.
  
  
  METHODS
  We analysed the available records of 30,834 Japanese patients with type 2 diabetes from the BioBank Japan Project between 2003 and 2007. Men and women were followed up for median 8.03 and 8.30 years, respectively. We applied Cox proportional hazard model and Kaplan-Meier estimates for survival curves to evaluate mortality in diabetic patients with or without macrovascular disease, chronic respiratory disease, chronic kidney disease, cancer and smoking.
  
  
  RESULTS
  Adjusted hazard ratios (HRs) for mortality were 1.39 (95% CI, 1.09-1.78) for male sex, 2.01 (95% CI, 1.78-2.26) per 10-year increment of age. Adjusted HRs of primary interest were 1.77 (95% CI, 1.42-2.22), macrovascular disease; 1.58 (95% CI, 1.08-2.31), chronic respiratory disease; 2.03 (95% CI, 1.67-2.47), chronic kidney disease; 1.16 (95% CI, 0.86-1.56), cancer; and 1.74 (95% CI, 1.30-2.31), current smoking.
  
  
  CONCLUSIONS
  Diabetic patients with a past or current history of chronic kidney, macrovascular or respiratory diseases or smoking habit have exhibited the highest risk of mortality. Data were limited to those of survivors of comorbidities but we propose the need to improve comorbidities and terminate cigarette smoking for better prognosis in patients with diabetes.
authors.affiliation: Department of Health Sciences, University of Yamanashi, Yamanashi, Japan. Electronic address: hyokomichi@yamanashi.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokomichi
authors.affiliation: Department of Public Policy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Nagai
authors.affiliation: Laboratory of Genome Technology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirata
authors.affiliation: Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
authors.affiliation: Department of Public Policy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Muto
authors.affiliation: Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Laboratory of Molecular Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kamatani
authors.affiliation: Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamakoshi
authors.affiliation: RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kubo
authors.affiliation: Laboratory of Molecular Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Health Sciences, University of Yamanashi, Yamanashi, Japan.
authors.forename: Zentaro
authors.initials: Z
authors.lastname: Yamagata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018070:Biological Specimen Banks; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology*; D016019:Survival Analysis; D014652:Vascular Diseases / Q000453:epidemiology*; D055815:Young Adult
keywords: Cancer; Cardiovascular diseases; Diabetes; Diabetes complications; Survival analysis