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Cardiovascular events and mortality in people with type 2 diabetes and multimorbidity: A real‐world study of patients followed for up to 19 years
Author(s) -
Coles Briana,
Zaccardi Francesco,
Hvid Christian,
Davies Melanie J.,
Khunti Kamlesh
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14218
Subject(s) - medicine , type 2 diabetes , hazard ratio , diabetes mellitus , comorbidity , retrospective cohort study , disease , cause of death , pediatrics , confidence interval , endocrinology
Aim To quantify the risk of cardiovascular disease (CVD) events, all‐cause mortality and cardiovascular mortality in patients diagnosed with type 2 diabetes (T2D) and multimorbidity. Methods This retrospective study used English primary and secondary care data to identify 120 409 adults newly diagnosed with T2D during 2000–2018 with follow‐up until death or 31 December 2018. Patients were classified according to the level and type of multimorbidity at T2D diagnosis, and adjusted hazard ratios (aHRs) were calculated for each outcome. Results In total, 66 977 (55.6%) patients had T2D only, 37 894 (31.5%) had one co‐morbidity, 11 357 (9.4%) had two co‐morbidities, 3186 (2.6%) patients had three co‐morbidities and 995 (0.8%) patients had four or more co‐morbidities. Co‐morbidities were associated with increased aHRs for all outcomes. Compared with patients with T2D only, at 19 years after diagnosis of T2D the aHR for four or more co‐morbidities was 2.57 (95% CI 2.45‐2.69) for a CVD event, 1.73 (1.68‐1.78) for all‐cause mortality and 2.68 (2.52–2.85) for cardiovascular mortality. Also, 100 183 (83.2%) patients had no CVD co‐morbidities, 16 874 (14.0%) patients had one CVD co‐morbidity and 3352 (2.8%) patients had two or more co‐morbidities. Compared with patients with no CVD co‐morbidities, at 19 years after diagnosis of T2D the aHR for two or more CVD co‐morbidities was 2.42 (2.35‐2.49) for a CVD event, 1.44 (1.42‐1.47) for all‐cause mortality and 2.44 (2.35‐2.54) for cardiovascular mortality. Conclusion In people with T2D, level of multimorbidity and, in particular, CVD multimorbidity increased the risk of subsequent CVD events, mortality and cardiovascular mortality.