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Diabetes and infectious disease mortality in Mexico City
Fiona Bragg1,2, Pablo Kuri-Morales3,4, Jaime Berumen5
1MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Introduction:
Although higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought to assess the risk of death from infection associated with diabetes in Mexico.
Research Design And Methods:
Between 1998 and 2004, a total of 159 755 adults ≥35 years were recruited from Mexico City and followed up until January 2021 for cause-specific mortality. Cox regression yielded adjusted rate ratios (RR) for death due to infection associated with previously diagnosed and undiagnosed (HbA1c ≥6.5%) diabetes and, among participants with previously diagnosed diabetes, with duration of diabetes and with HbA1c.
Results:
Among 130 997 participants aged 35-74 and without other prior chronic diseases at recruitment, 12.3% had previously diagnosed diabetes, with a mean (SD) HbA1c of 9.1% (2.5%), and 4.9% had undiagnosed diabetes. During 2.1 million person-years of follow-up, 2030 deaths due to infectious causes were recorded at ages 35-74. Previously diagnosed diabetes was associated with an RR for death from infection of 4.48 (95% CI 4.05-4.95), compared with participants without diabetes, with notably strong associations with death from urinary tract (9.68 (7.07-13.3)) and skin, bone and connective tissue (9.19 (5.92-14.3)) infections and septicemia (8.37 (5.97-11.7)). In those with previously diagnosed diabetes, longer diabetes duration (1.03 (1.02-1.05) per 1 year) and higher HbA1c (1.12 (1.08-1.15) per 1.0%) were independently associated with higher risk of death due to infection. Even among participants with undiagnosed diabetes, the risk of death due to infection was nearly treble the risk of those without diabetes (2.69 (2.31-3.13)).
Conclusions:
In this study of Mexican adults, diabetes was common, frequently poorly controlled, and associated with much higher risks of death due to infection than observed previously, accounting for approximately one-third of all premature mortality due to infection.
Insights
Diabetes significantly increases the risk of death from infections in Mexican adults. This includes both diagnosed and undiagnosed cases, highlighting the urgent need for better diabetes management and infection prevention strategies.
Area of Science:
- Epidemiology
- Infectious Diseases
- Diabetes Mellitus
Background:
- Diabetes is a known risk factor for infectious diseases, but the extent of this risk, especially in low-income regions, is not well-defined.
- In Mexico, diabetes prevalence is substantial, and its impact on mortality from infections requires further investigation.
Purpose of the Study:
- To determine the risk of death from infections associated with diabetes in a large cohort of Mexican adults.
- To examine the influence of diabetes duration and glycemic control (HbA1c) on infection-related mortality.
Main Methods:
- A prospective cohort study involving 159,755 adults aged 35 years and older in Mexico City, recruited between 1998 and 2004.
- Cause-specific mortality data were collected until January 2021, with Cox regression used to analyze the association between diabetes status (diagnosed and undiagnosed) and infection-related death.
- Adjusted rate ratios (RR) were calculated, considering diabetes duration and HbA1c levels for those with diagnosed diabetes.
Main Results:
- Previously diagnosed diabetes was linked to a 4.48-fold increased risk of death from infection (RR 4.48, 95% CI 4.05-4.95).
- Strong associations were observed for deaths from urinary tract infections (RR 9.68), skin/bone/connective tissue infections (RR 9.19), and septicemia (RR 8.37).
- Higher diabetes duration and HbA1c levels independently increased infection-related mortality risk. Undiagnosed diabetes nearly tripled the risk (RR 2.69).
Conclusions:
- Diabetes is prevalent and often poorly controlled in Mexican adults, significantly elevating the risk of fatal infections.
- Diabetes accounts for approximately one-third of all premature deaths attributed to infection in this population.
- These findings underscore the critical need for improved diabetes care and public health interventions to mitigate infection-related mortality.
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