Women with type 2 diabetes had worse mortality outcomes than men (SMRd 1.60 vs 1.44), with 55% of excess female deaths attributed to differences in risk factors and cardioprotective prescribing.
Cohort (n=11,806)
Do sex differences in cardiovascular risk factor control and cardioprotective medication prescribing explain worse mortality in women with type 2 diabetes?
Women with type 2 diabetes experience worse mortality outcomes than men, which is significantly driven by a higher prevalence of adverse risk factors and under-prescription of cardioprotective medications like ACE inhibitors, ARBs, and SGLT2 inhibitors.
Absolute Event Rate: 1.6% vs 1.44%
Abstract Introduction The standardised mortality rate (SMR) for people with diabetes in England is 1.5–1.7, with differences in outcomes between sexes. There has been little work examining the factors that could have an impact on this or on what may determine sex differences in outcome. Methods Data were extracted for patients with type 2 diabetes (T2D) in Salford (England) in 2010 for the years up to 2020, including any deaths recorded. Expected deaths were calculated from annual Office of National Statistics mortality rate and life expectancy by age and gender, adjusted for the local Index of Multiple Deprivation (IMD). This provided the SMR deprivation (SMRd), and life expectancy years lost per death (LEYLD). The effects of treatment type, and clinical features on SMRd relative to sex were examined by univariable and multivariable analysis. Results Data from n = 11,806 ( F = 5184; M = 6622) patients were included. Of these, n = 5540 were newly diagnosed and n = 3921 died ( F = 1841; M = 2080). In total, n = 78,930 patient years. The expected deaths numbered n = 2596 (adjusted for age, sex, and IMD). Excess deaths were n = 1325 ( F = 689; M = 636). Life expectancy years lost (LEYL) 18,989 ( F = 9714; M = 9275). SMRd 1.51 ( F = 1.60; M = 1.44) and LEYLD 4.84 years ( F = 5.28; M = 4.46). The impact of risk factors was not different by sex. However, women had higher prevalence of % diagnosed >65 years of age; % last eGFR <60 mLs/min/1.73 m 2 , and lower prevalence of % prescribed ACE‐inhibitor/ARB, DPP4‐inhibitor and SGLT2‐inhibitor. Applying the male prevalence rate to the female population and expected mortality suggested n = 437 (55%) of excess T2D female deaths were attributed to sex difference in the prevalence of these risk and protective factors. Conclusions Outcomes in women with T2DM are worse than in men, contributed to by greater prevalence of adverse factors and less prescribing of cardioprotective medication.
Stedman et al. (Thu,) conducted a cohort in Type 2 diabetes (n=11,806). Female sex vs. Male sex was evaluated on Standardised mortality rate deprivation (SMRd). Women with type 2 diabetes had worse mortality outcomes than men (SMRd 1.60 vs 1.44), with 55% of excess female deaths attributed to differences in risk factors and cardioprotective prescribing.
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