Diabetes and number of years of life lost with and without cardiovascular disease: a multi-state homogeneous semi-Markov model.
AIMS
We quantified the impact of type 2 diabetes on incidence of non-fatal cardiovascular disease (CVD) and mortality, considering CVD as a continuum from occurrence of diabetes to the end point, and estimated the 15-year life expectancy with and without CVD.


METHODS
A total of 7239 Iranian adults (3246 men), aged ≥ 30 years, were followed from 1999 to 2014. We applied a multi-state semi-Markov model with three transitions including CVD-free to non-fatal CVD, CVD-free to death and non-fatal CVD to death, and studied the influence of diabetes on each transition rate, stratifying by sex and adjusting for confounders.


RESULTS
Diabetes was significantly associated with increased risk of non-fatal CVD in men [hazard ratio, 1.70 (1.36-3.53)] and women [2.19 (1.74-2.77)], and of all-cause death [2.72 (2.03-3.63) and 1.92 (1.37-2.67) in men and women, respectively]. An increased risk of mortality was found only among diabetic men, when non-fatal CVD was occurred [2.19 (1.36-3.53)]. Men with diabetes experienced first non-fatal CVD and death without CVD 1.7 and 1.4 years, respectively, earlier than those without diabetes; the corresponding values were 1.4 and 0.7 years for women. Moreover, diabetic men lived 1.3 years less than non-diabetic counterparts when non-fatal CVD was occurred.


CONCLUSIONS
Diabetes increased the risk of non-fatal CVD events and all-cause mortality and consequently decreased the number of years lived without CVD. A decrease in LE was found only among diabetic men compared to non-diabetics after non-fatal CVD occurred.
['Ramezankhani|Azra|A|', 'Azizi|Fereidoun|F|', 'Hadaegh|Farzad|F|http://orcid.org/0000-0002-8935-2744', 'Momenan|Amir Abbas|AA|']
D000328:Adult D000368:Aged D002318:Cardiovascular Diseases D003924:Diabetes Mellitus, Type 2 D003925:Diabetic Angiopathies D005260:Female D006801:Humans D015994:Incidence D007492:Iran D008017:Life Expectancy D008297:Male D008390:Markov Chains D008875:Middle Aged D016016:Proportional Hazards Models D012307:Risk Factors
Diabetes Cardiovascular disease Multi-state Mortality Markov model