Fig. 1Adjusted Kaplan-Meier survival curves for cumulative all-cause and other mortality according to diagnosed diabetes category: (A) all-cause, (B) cardiovascular disease (CVD), (C) cancer, (D) chronic lower respiratory disease (CLRD), (E) accidents, (F) cerebrovascular disease (CeVD), (G) Alzheimer's disease (AD), (H) flu & pneumonia, and (I) kidney disease.
Fig. 2Adjusted Kaplan-Meier survival curves for cumulative all-cause and other mortality according to diabetes status category: (A) all-cause, (B) cardiovascular disease (CVD), (C) cancer, (D) chronic lower respiratory disease (CLRD), (E) accidents, (F) cerebrovascular disease (CeVD), (G) Alzheimer's disease (AD), (H) flu & pneumonia, and (I) kidney disease.
Table 1Weighted characteristics of the study population: National Health and Nutrition Examination Survey 1999 to 2010
Variable |
Overall |
Diagnosed diabetes |
Diabetes status |
No. (%) |
SE |
Yes |
No |
P value |
Diabetes |
Pre-diabetes |
No diabetes |
P value |
No. (%) |
SE |
No. (%) |
SE |
No. (%) |
SE |
No. (%) |
SE |
No. (%) |
SE |
Sex |
|
|
|
|
|
|
0.11 |
|
|
|
|
|
|
0.01 |
Male |
7,773 (47.61) |
0.42 |
1,231 (49.67) |
1.32 |
6,542 (47.36) |
0.46 |
1,506 (50.84) |
1.09 |
1,895 (46.31) |
1.04 |
4,372 (47.36) |
0.54 |
Female |
7,740 (52.39) |
0.42 |
1,165 (50.33) |
1.32 |
6,575 (52.64) |
0.46 |
1,403 (49.16) |
1.09 |
1,875 (53.69) |
1.04 |
4,462 (52.64) |
0.54 |
Age, yr |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
40–49 |
4,149 (35.03) |
0.73 |
297 (17.20) |
1.33 |
3,852 (37.25) |
0.77 |
379 (17.56) |
1.16 |
685 (22.93) |
1.03 |
3,085 (42.41) |
0.92 |
50–59 |
3,372 (28.60) |
0.55 |
475 (26.98) |
1.34 |
2,897 (28.80) |
0.59 |
590 (27.72) |
1.23 |
788 (29.04) |
1.06 |
1,994 (28.65) |
0.75 |
60–69 |
3,731 (18.18) |
0.41 |
833 (28.75) |
1.13 |
2,898 (16.86) |
0.44 |
999 (28.37) |
1.04 |
1,055 (22.95) |
0.80 |
1,677 (14.59) |
0.54 |
≥70 |
4,261 (18.19) |
0.50 |
791 (27.06) |
1.12 |
3,470 (17.08) |
0.49 |
941 (26.35) |
0.90 |
1,242 (25.07) |
0.89 |
2,078 (14.35) |
0.50 |
Race |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
White |
8,468 (77.68) |
1.12 |
963 (65.32) |
2.09 |
7,505 (79.21) |
1.06 |
1,161 (65.00) |
2.08 |
1,869 (71.49) |
1.68 |
5,438 (82.22) |
0.94 |
Black |
2,840 (9.21) |
0.63 |
600 (15.31) |
1.37 |
2,240 (8.45) |
0.57 |
722 (15.18) |
1.29 |
859 (13.06) |
1.01 |
1,259 (6.78) |
0.48 |
Others |
4,205 (13.11) |
0.94 |
833 (19.37) |
1.84 |
3,372 (12.33) |
0.87 |
1,026 (19.82) |
1.81 |
1,042 (15.45) |
1.32 |
2,137 (11.00) |
0.77 |
Education |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
<High school |
4,906 (19.06) |
0.66 |
1,045 (30.62) |
1.16 |
3,861 (17.62) |
0.66 |
1,273 (30.56) |
1.12 |
1,288 (23.49) |
0.94 |
2,345 (15.32) |
0.67 |
=High school |
3,645 (25.56) |
0.52 |
525 (25.21) |
1.22 |
3,120 (25.60) |
0.54 |
639 (25.44) |
1.20 |
947 (28.22) |
1.14 |
2,059 (24.74) |
0.54 |
>High school |
6,962 (55.38) |
0.90 |
826 (44.17) |
1.43 |
6,136 (56.78) |
0.92 |
997 (44.00) |
1.32 |
1,535 (48.29) |
1.41 |
4,430 (59.94) |
0.96 |
PIR |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
<1 |
2,520 (9.98) |
0.44 |
523 (14.92) |
0.88 |
1,997 (9.37) |
0.44 |
633 (15.03) |
0.94 |
635 (10.97) |
0.73 |
1,252 (8.64) |
0.45 |
1≤PIR≤median |
5,723 (28.46) |
0.73 |
1,021 (37.93) |
1.10 |
4,702 (27.28) |
0.76 |
1,248 (37.79) |
1.07 |
1,489 (33.41) |
1.20 |
2,986 (25.00) |
0.77 |
>Median |
7,270 (61.55) |
0.99 |
852 (47.15) |
1.32 |
6,418 (63.35) |
1.03 |
1,028 (47.18) |
1.30 |
1,646 (55.62) |
1.41 |
4,596 (66.36) |
1.05 |
BMI, kg/m2
|
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
<25 |
4,109 (28.50) |
0.59 |
347 (14.30) |
1.15 |
3,762 (30.27) |
0.63 |
393 (12.97) |
1.00 |
809 (21.11) |
0.85 |
2,907 (34.00) |
0.77 |
≥25 |
11,404 (71.50) |
0.59 |
2,049 (85.70) |
1.15 |
9,355 (69.73) |
0.63 |
2,516 (87.03) |
1.00 |
2,961 (78.89) |
0.85 |
5,927 (66.00) |
0.77 |
Smoking |
|
|
|
|
|
|
0.39 |
|
|
|
|
|
|
0.16 |
Yes |
8,102 (51.45) |
0.68 |
1,261 (52.52) |
1.42 |
6,841 (51.32) |
0.69 |
1,553 (53.05) |
1.45 |
1,988 (52.64) |
1.04 |
4,561 (50.75) |
0.85 |
No |
7,411 (48.55) |
0.68 |
1,135 (47.48) |
1.42 |
6,276 (48.68) |
0.69 |
1,356 (46.95) |
1.45 |
1,782 (47.36) |
1.04 |
4,273 (49.25) |
0.85 |
Alcohol use |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
Yes |
10,549 (71.65) |
0.95 |
1,393 (59.53) |
1.42 |
9,156 (73.16) |
0.94 |
1,713 (59.90) |
1.40 |
|
1.22 |
6,357 (75.33) |
0.96 |
No |
4,964 (28.35) |
0.95 |
1,003 (40.47) |
1.42 |
3,961 (26.84) |
0.94 |
1,196 (40.10) |
1.40 |
1,291 (32.41) |
1.22 |
2,477 (24.67) |
0.96 |
High blood pressure |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
Yes |
6,959 (39.59) |
0.67 |
1,670 (68.18) |
1.43 |
5,289 (36.03) |
0.65 |
1,942 (65.56) |
1.26 |
1,852 (46.60) |
1.07 |
3,165 (32.07) |
0.74 |
No |
8,554 (60.41) |
0.67 |
726 (31.82) |
1.43 |
7,828 (63.97) |
0.65 |
967 (34.44) |
1.26 |
1,918 (53.40) |
1.07 |
5,669 (67.93) |
0.74 |
Physical activity |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
Yes |
8,695 (63.53) |
0.82 |
1,075 (50.32) |
1.41 |
7,620 (65.18) |
0.85 |
1,306 (49.52) |
1.32 |
2,059 (59.81) |
1.09 |
5,330 (67.57) |
0.90 |
No |
6,818 (36.47) |
0.82 |
1,321 (49.68) |
1.41 |
5,497 (34.82) |
0.85 |
1,603 (50.48) |
1.32 |
1,711 (40.19) |
1.09 |
3,504 (32.43) |
0.90 |
Deaths |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
All-cause |
2,042 (9.39) |
0.41 |
480 (18.29) |
1.00 |
1,562 (8.29) |
0.39 |
<0.01 |
549 (17.27) |
0.90 |
484 (10.09) |
0.65 |
1,009 (7.56) |
0.42 |
<0.01 |
CVD |
409 (1.80) |
0.13 |
102 (3.93) |
0.51 |
307 (1.53) |
0.12 |
<0.01 |
115 (3.51) |
0.45 |
103 (1.92) |
0.22 |
191 (1.40) |
0.14 |
<0.01 |
Cancer |
483 (2.38) |
0.15 |
81 (3.00) |
0.46 |
402 (2.30) |
0.16 |
0.12 |
98 (3.03) |
0.40 |
124 (2.91) |
0.31 |
261 (2.08) |
0.18 |
<0.01 |
CLRD |
117 (0.60) |
0.07 |
25 (1.14) |
0.24 |
92 (0.54) |
0.08 |
<0.01 |
31 (1.21) |
0.22 |
32 (0.72) |
0.16 |
54 (0.44) |
0.08 |
<0.01 |
Accidents |
58 (0.31) |
0.06 |
8 (0.21) |
0.10 |
50 (0.33) |
0.07 |
0.39 |
11 (0.37) |
0.16 |
13 (0.30) |
0.11 |
34 (0.31) |
0.07 |
0.92 |
CeVD |
128 (0.54) |
0.06 |
28 (1.33) |
0.27 |
100 (0.44) |
0.05 |
<0.01 |
31 (1.15) |
0.23 |
23 (0.43) |
0.12 |
74 (0.44) |
0.06 |
<0.01 |
AD |
56 (0.27) |
0.04 |
5 (0.18) |
0.10 |
51 (0.28) |
0.04 |
0.43 |
8 (0.23) |
0.08 |
11 (0.23) |
0.07 |
37 (0.29) |
0.05 |
0.75 |
Flu & pneumonia |
47 (0.19) |
0.04 |
18 (0.58) |
0.22 |
29 (0.14) |
0.04 |
<0.01 |
19 (0.51) |
0.18 |
7 (0.09) |
0.04 |
21 (0.15) |
0.04 |
<0.01 |
Kidney disease |
51 (0.18) |
0.04 |
19 (0.51) |
0.16 |
32 (0.13) |
0.03 |
<0.01 |
20 (0.48) |
0.15 |
10 (0.16) |
0.06 |
21 (0.12) |
0.03 |
<0.01 |
Table 2Hazard ratio for all-cause and other mortality by diagnosed diabetes category: National Health and Nutrition Examination Survey 1999 to 2010
Cause of death/diagnosed diabetes |
No. of deaths |
Crude model |
Adjusted modela
|
cHR |
LL |
UL |
aHR |
LL |
UL |
All-cause |
2,042 |
|
|
|
|
|
|
Yes |
480 |
1.91 |
1.72 |
2.12 |
1.68 |
1.52 |
1.87 |
No |
1,562 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
Pvalue |
|
<0.01 |
|
|
<0.01 |
|
|
CVD |
409 |
|
|
|
|
|
|
Yes |
102 |
2.06 |
1.64 |
2.57 |
1.81 |
1.44 |
2.27 |
No |
307 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Cancer |
483 |
|
|
|
|
|
|
Yes |
81 |
1.24 |
0.98 |
1.58 |
1.08 |
0.85 |
1.38 |
No |
402 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.08 |
|
|
0.52 |
|
|
CLRD |
117 |
|
|
|
|
|
|
Yes |
25 |
1.68 |
1.08 |
2.61 |
1.58 |
1.01 |
2.48 |
No |
92 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.02 |
|
|
0.05 |
|
|
Accidents |
58 |
|
|
|
|
|
|
Yes |
8 |
1.01 |
0.48 |
2.12 |
0.91 |
0.43 |
1.93 |
No |
50 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.99 |
|
|
0.80 |
|
|
CeVD |
128 |
|
|
|
|
|
|
Yes |
28 |
1.73 |
1.14 |
2.64 |
1.54 |
1.00 |
2.35 |
No |
100 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.01 |
|
|
0.05 |
|
|
AD |
56 |
|
|
|
|
|
|
Yes |
5 |
0.63 |
0.25 |
1.57 |
0.69 |
0.27 |
1.75 |
No |
51 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.32 |
|
|
0.44 |
|
|
Flu & pneumonia |
47 |
|
|
|
|
|
|
Yes |
18 |
3.90 |
2.16 |
7.03 |
3.56 |
1.95 |
6.49 |
No |
29 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Kidney disease |
51 |
|
|
|
|
|
|
Yes |
19 |
3.69 |
2.09 |
6.51 |
3.00 |
1.68 |
5.35 |
No |
32 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Table 3Hazard ratio for all-cause and other mortality by diabetes status category: National Health and Nutrition Examination Survey 1999 to 2010
Cause of death/diabetes status |
No. of deaths |
Crude model |
Adjusted modela |
cHR |
LL |
UL |
aHR |
LL |
UL |
All-cause |
2,042 |
|
|
|
|
|
|
Diabetes |
549 |
2.01 |
1.81 |
2.23 |
1.64 |
1.47 |
1.82 |
Pre-diabetes |
484 |
1.44 |
1.29 |
1.60 |
1.07 |
0.96 |
1.20 |
No diabetes |
1,009 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
CVD |
409 |
|
|
|
|
|
|
Diabetes |
115 |
2.21 |
1.75 |
2.79 |
1.79 |
1.42 |
2.27 |
Pre-diabetes |
103 |
1.60 |
1.26 |
2.04 |
1.18 |
0.93 |
1.51 |
No diabetes |
191 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Cancer |
483 |
|
|
|
|
|
|
Diabetes |
98 |
1.37 |
1.08 |
1.73 |
1.11 |
0.88 |
1.41 |
Pre-diabetes |
124 |
1.40 |
1.13 |
1.73 |
1.09 |
0.88 |
1.35 |
No diabetes |
261 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
0.34 |
|
|
CLRD |
117 |
|
|
|
|
|
|
Diabetes |
31 |
2.10 |
1.35 |
3.26 |
1.89 |
1.20 |
2.98 |
Pre-diabetes |
32 |
1.75 |
1.13 |
2.71 |
1.36 |
0.87 |
2.12 |
No diabetes |
54 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Accidents |
58 |
|
|
|
|
|
|
Diabetes |
11 |
1.21 |
0.61 |
2.40 |
1.06 |
0.53 |
2.13 |
Pre-diabetes |
13 |
1.17 |
0.62 |
2.21 |
0.98 |
0.51 |
1.87 |
No diabetes |
34 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.53 |
|
|
0.90 |
|
|
CeVD |
128 |
|
|
|
|
|
|
Diabetes |
31 |
1.54 |
1.01 |
2.34 |
1.23 |
0.80 |
1.88 |
Pre-diabetes |
23 |
0.92 |
0.58 |
1.48 |
0.66 |
0.41 |
1.06 |
No diabetes |
74 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.09 |
|
|
0.70 |
|
|
AD |
56 |
|
|
|
|
|
|
Diabetes |
8 |
0.84 |
0.39 |
1.80 |
0.85 |
0.39 |
1.84 |
Pre-diabetes |
11 |
0.95 |
0.48 |
1.87 |
0.70 |
0.35 |
1.37 |
No diabetes |
37 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
0.65 |
|
|
0.45 |
|
|
Flu & pneumonia |
47 |
|
|
|
|
|
|
Diabetes |
19 |
3.40 |
1.83 |
6.33 |
2.86 |
1.51 |
5.43 |
Pre-diabetes |
7 |
1.02 |
0.44 |
2.41 |
0.76 |
0.32 |
1.79 |
No diabetes |
21 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|
Kidney disease |
51 |
|
|
|
|
|
|
Diabetes |
20 |
3.51 |
1.90 |
6.48 |
2.52 |
1.34 |
4.71 |
Pre-diabetes |
10 |
1.42 |
0.67 |
3.02 |
0.95 |
0.45 |
2.03 |
No diabetes |
21 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
P value |
|
<0.01 |
|
|
<0.01 |
|
|