Risk factors for mortality among people with diabetes in Spain: The DIMORTES study

Diabetes mellitus (DM) is a common chronic disease with an increasing global prevalence.

The objective of this study was to analyse all-cause mortality and its associated factors in people with DM in Spain.

We conducted a population-based retrospective study based on the 2011/2012 Spanish National Health Survey and the Spanish national death register, with six years of follow-up. The response variable was all-cause mortality, and explanatory variables included sociodemographic characteristics, health characteristics, use of health services, and lifestyle habits.

Of the 14,784 respondents aged over 40 years, 1781 (12.0 %) had a diagnosis of DM. There were 350 deaths during follow-up (19.7 % cumulative incidence of all-cause mortality). The most common comorbidities in people with DM included overweight and obesity (68.7 %), hypertension (60.9 %) and hypercholesterolemia (51.4 %). The main factors associated with mortality were a diagnosis of chronic obstructive pulmonary disease (Hazard Ratio (HR) 1.43 95 % CI 1.01-2.03); hospital admission in the last year (HR 1.52, 95 % CI 1.15-2.01); depressive disorder (HR 1.53, 95 % CI 1.05-2.23); and smoking (HR 1.84, 95 % CI 1.11-3.05). The association between mortality and history of acute myocardial infarction was time dependent, strengthening considerably over the follow-up period.

Among people with DM, there are significant associations between mortality and concomitant chronic respiratory disease, depressive disorder, hospital admission in the last year, and smoking. Greater efforts are required in the detection and management of these comorbidities in DM owing to their implication in mortality risk.