The Risk Analysis Of Diabetes By Using Its Prevalence And Mortality In Shanghai

Diabetes Mellitus (DM, all terms used in this thesis are referred to type 2 diabetes if it is not specifically notified) is an increasingly common, serious metabolic disorder caused by multiple factors. It is characterized with a substantial inherited component as well as social, life-style and environmental factors which are quite similar with other non-communicable diseases such as cardiac-cerebral vascular diseases. Integrated measures are the core of diabetes prevention and treatment, while evaluating disease outcome and controlling risk factors of diabetes are considered as the premise of its prevention and treatment. Therefore, to know its prevalence, mortality, and distribution of the risk factors should be the basis for the decision making for both diabetes prevention and life-quality promotion of diabetes cases.Part 1. A communinty based study of the prevalence of Type 2 Diabetes mellitusOBJECTIVETo investigate the prevalence and distribution of type 2 Diabetes mellitus (DM),impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in an adultgroup at age 15-74 years in Shanghai.METHODSThe method of multi-step cluster sampling was adopted. 14,401 adults at 15-74 yearsof age of Han Chinese were chosen as the sample from 2002 to 2003 in Shanghai. Thecross-sectional study surveys had played positive roles in calculating the prevalenceand distributions of Type 2 Diabetes mellitus (DM), impaired glucose tolerance (IGT)and impaired fasting glucose (IFG). The 1999 WHO criteria was accepted as the goldstandard for diagnosis of Type 2 Diabetes mellitus (DM). For those Type 2 Diabetespatients, we formulated the relevant blood glucose control policies and evaluated theoutcome.RESULTSThe overall or crude prevalence of Type 2 Diabetes mellitus was 10.17% in adults atage 15-74 years. The World Age Standardized Rate (WASR), Chinese AgeStandardized Rate (CASR) and Shanghai population Age Standardized Rate (SASR)were 5.69% (95%CI: 5.31%-6.07%), 6.20% (95%CI: 5.81%-6.59%) and 7.29% (95%CI: 6.87%-7.72%) respectively. The overall or crude prevalence of IGT was 6.51%. WASR, CASR and SASR were 4.62% (95%CI: 4.28%-4.97%), 4.74% (95%CI: 4.40%-5.09%), and 5.20% (95%CI: 4.84%-5.57%) respectively. The overall or crude prevalence of IFG was 1.64%. WASR, CASR and SASR were 1.04% (95%CI: 0.88%-1.21%), 1.05% (95%CI: 0.88%-1.22%), and 1.18% (95%CI: 1.00%-1.36%) respectively.The prevalence of DM increased with age. The prevalence of DM was higher in males than females (6.31%vs5.03% P<0.05) . Geographic analysis of prevalence showed that the rate in the urban was higher than that in rural (6.69%vs 3.59%, P<0.05) . The proportion of hidden DM was 45.7%. 4.16% of the diagnosed diabetes patients receive no treatment. The proportion of DM with poor blood glucose control or low blood glucose was 64.53% and 1.89% respectively. The proportion of those who can control their blood glucose levels as close as possible to normal was 33.58%. CONCLUSIONHigh prevalence of DM will present a serious challenge to Shanghai. Community-based disease prevention and control is vital and urgent. Part 2. Risk factors of Type 2 DMOBJECTIVETo analyze the risk factors of type 2 DM and its population distributions. METHODSThe method of multi-step cluster sampling was adopted. 14 401 adults at age 15-74 years of Han Chinese were chosen as the sample from 2002 to 2003 in Shanghai. The cross-sectional study surveys had played positive roles in understanding risk factors of type 2 DM and its population distributions. The relationship between DM and its risk factors was investigated using data from an integrated series of case-control studies. All 669 cases of being diagnosed as DM for the first time were paired with those from Shanghai Diabetes Epidemiological Investigation database by random selecting under the matching condition. The rick factors wereanalyzed with one-way and multinomial logistic regression model.RESULTS1. Epidemiological feature of overweight and obesity in Shanghai community residents.The proportion of overweight, the simple obesity, the abdominal obesity and the uneven distribution of fat were 35.84%, 1.78%, 39.75% and 6.41% respectively. Standardized by global population, the proportion of overweight was 29.05%, the simple obesity was 8.90%, the abdominal obesity was 30.20%, and the uneven distribution of fat was 5.45%. All the proportions above rosewith age correspondingly. There was higher prevalence rate of DM, IGT and IFG among the overweight than that in non-overweight (OR was 2.19, 1.91 and 2.43 respectively). There was higher prevalence rate of DM, IGT and IFG among the obese than that in non-obese (OR was 3.28, 2.54 and 4.10 respectively). There was higher prevalence rate of DM, IGT and IFG among people with abdominal obesity than that in people with non-abdominal obesity (OR was 3.16, 2.25 and 2.19 respectively). Pair study showed that there is much closer relationship between diabetes and obesity, especially the abdominal obesity. It showed that individual with obesity and abdominal obesity simultaneously had higher risk for diabetes. The study also showed that there was dose-response relation between h diabetes and BMI, WHR and waist circumference.2. Relationship between hypertension and DM in Shanghai community residents. The prevalence rate of hypertension was 27.02%. While standardized by global population, it was 15.91%. Higher prevalence existed in males than that in females(18.54%vs13.13% ,P<0.05) , and the prevalence rate was higher in urban than in rural area (18.02%vs 12.28%, P<0.05 ). There was higher prevalence rate of DM, IGT and IFG among people with hypertension than that in non-hypertensive people (OR was 3.47, 1.97 and 2.95 respectively). Pair study showed that the OR for DM among people with hypertension comparedwith the non-hypertensive people was 2.30.3. Relationship between hypercholesterolaemia and DM in Shanghai community residents.The prevalence rate of hypercholesterolaemia was 41.97%. While standardized by global population, it was 35.08%. There was higher prevalence rate in males than in females (40.71%vs29.10%, P<0.05) , and the prevalence rate was lower in urban than in rural area (41.36%vs45.19%, P<0.05). There was higher prevalence rate of DM, IGT and IFG among people with hypercholesterolaemia than people withouthypercholesterolaemia (OR was 2.72, 2.08 and 1.79 respectively). Pair studyshowed that OR for DM among popele with hypercholesterolaemia compared withthose withouthypercholesterolaemia was 2.99.4. The main risk factors of type 2 DM among Shanghai community residents.The main risk factors of type 2 DM included: obesity especially abdominal obesity,hypercholesterolaemia and hypertension. Individuals with family history were highrisky population for diabetes. Obesity, especially the abdominal obesity, had closerelation with diabetes. Among the blood lipid indices, TC, TG and HDL-C showed tobe related to DM. The presence of hypercholesterolaemia and hypertension couldincrease the risk of diabetes. Multinomial logistic regression analysis was the bestmethod among all methods of modeling with factors above.CONCLUSIONThe key risk factors for DM include: family history, abdominal obesity, hypertensionand Hypercholesterolaemia. All of the risk factors are prevalent in the Shanghaicommunity.Part 3. Trend and Risk Analysis of DM mortality during 1994-2004OBJECTIVETo Evaluate mortality trend and risks of DM from 1994 to 2004 in Shanghai residents.METHODEpidemiological analysis for mortality of DM in Shanghai residents from 1994 to2004 was based on Shanghai Cause of Death Register System and also partly on thePublic Security Bureau System. Through comparing DM as underlying cause(so-called DM) and mentioned cause [so-called DM(mentioned)] to mortality death tothe all causes to mortality, the mortality risks of DM were evaluated. By analysis ofco-mobidity diseases of DM, mortality risks of DM were evaluated indirectly.RESULTSCrude mortality of DM was higher in the urban than that in the suburban, higher infemales than that in males. Crude mortality of DM(mentioned) was higher than that ofDM and that of injury which was the lowest among five primary causes to mortality.Crude mortality of both DM and DM(mentioned) rose slightly with an annualaverage growth rate ofs 7.01%, 5.36 in cities and 12.01% in rural area respectively.After standardization mortality of DM in 1996 was 11.40 per 100,000 and 13.11 per100,000 in 2003, while mortality of DM(mentioned) in 1996 was 15.50 per 100,000and 27.90 per 100,000 in 2003.Recent research data showed that the average death age among DM cases in Shanghaiwas over 70 years old. The average death age rose in last 10 years. It was higher infemales than that in males, and the age gap between them tends to expand.The main co-morbility diseases were urological diseases, hypertension,cerebrovascular disease and heart disease, while less important ones were nervoussystem disease and blood disease. Among which urological diseases, hypertension,cerebrovascular diseases, and hyper-cholesterolaemia hade significant relation withdiabetes.Descriptive analysis showed social characteristics of individuals with DM mortalitydiffered among their occupations, education level and marriage status. Labor workershad the higher mortality risk. The individuals with higher education background gotthe lower mortality risk. Married individuals had lower risk than those unmarried.CONCLUSIONThe mortality of DM in Shanghai residents rises year by year. DM becomes one ofmajor chronic disease endangering residents' health.Part 4. Forecasting Model for High Risk Groups of Type 2 DMOBJECTIVETo establish screening method for type 2 DM high risky groups by risk factors scoring and Logistic Regression modelling. To assess the utility value of forecasting model for predicting risky groups of type 2 DM. METHOD2 groups were selected randomly as training and test based on cross-sectional study. The sample size for training was 6147 and the amount of those being diagnosed for the first time was 332, while test was 6148 and the amount of those being diagnosed for the first time was 325. The study of risk factors and screening method establishment were carried out among the training group. The screening method concluded from training group was applied to test group later, and screening index for individuals was calculated includingsensitivity, specificity, Youden's index and positive predictive value The value screening threshold was concluded based onYouden's Index and the accumulated distribution curve of first-timediagnosed diabetic patients. The utility value of screening method was be evaluated by the square measure below ROC curve and the feasibility of the method. RESULTSThe sensitivity of risk factor scoring method was 72.31%, and the specificity was 67.25%. The sensitivity of Logistic Regression Model method was 72.62%, and the specialty was 61.39%. The square measure below ROC for risk factors scoring was 0.765, while that for Logistic Regression was 0.724. The risk factor scoring method had the more larger square below ROC and the more obvious threshold point on Form left Coordinate curve. CONCLUSIONThe risk factor scoring method is more convenient, effective than the Logistic Regression Model method, thus it can be used in screening for DM high-risk population. EpilogueTotally 8 testing communities were selected to conduct community diagnosis and 14,401 residents were involved into the diabetes epidemiology research in this study. Diabetes death cases based on Shanghai Death Registry were analyzed to evaluate diabete mortality and its riks. The study explored the epidemiological feature and key risk factors of type 2 Diabetes mellitus (DM) among Shanghai sueveryed residents at 15-74 years of age. The prevalence of diabetes rose to a high level according to results, and the mortality roses annually as well, which made diabetes one of the most important causes of death among Shanghai residents. Calculating based on the lower value of prevalence as 8%, it is estimated that there are over 1 million diabetes patients (with complication) in the total 13 million Shanghai residents. In this way, total economical cost will reach RMB 20 billion based on annual medical expenditure of RMB 2,000 per person. Diabetes will become one of issues slowing down development of Shanghai society and economy as the society ages. The study established and evaluated screening methods for high risk diabetes population among community residents according to heredity and environmental risk factor. Based onthe screening methods, constructive prevention strategy and measures were proposed, which will be beneficial to the implementation of primary and secondary prevention measures. High risk diabetes population could be predicted by family history, obesity, hypercholesterolaemia and hypertension. Prevention could be effective by applying such measures as health education and health promotion for general population to cultivate healthy lifestyle , proactive diagnose of hypertension and weight control.The prevention and control strategy for diabetes will endure for long period. The study provides suggestions below: 1) To explore the relation between risk factor and diabetes through long-term dynamic observation among high risk diabetes population cohort. 2) To make policies based on surveillance and cause analysis of controllable risk factor like environment and lifestyle, which will help in buiding up healthy environment and behavior for diabetes prevention and control. 3) To conduct early detection and individualized intervention, and evaluate the cost-effectiveness of reducing or slowing down diabetes. 4) To make diabetes patient management strategy tailored to Shanghai community residents, explore community service model fit for Shanghai community residents, and establish individualized diabetes intervention measure, and to reduce diabetes complications by means of comprehensive management integrating medication, diet, physical activities and psychological measure, in this way, life quality of life of patients with diabetes will be improved.