Diabetes and the risk of hospitalisation for infection: the Atherosclerosis Risk in Communities (ARIC) study,Diabetologia

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Diabetes and the risk of hospitalisation for infection: the Atherosclerosis Risk in Communities (ARIC) study
Diabetologia ( IF 8.4 ) Pub Date : 2021-08-04 , DOI: 10.1007/s00125-021-05522-3
Michael Fang _{1,

2} , Junichi Ishigami _{1,

2} , Justin B Echouffo-Tcheugui ₃ , Pamela L Lutsey ₄ , James S Pankow ₄ , Elizabeth Selvin _{1,

2}

Affiliation

Aims/hypothesis

The aim of this work was to assess the association between diabetes and risk for infection-related hospitalisation and mortality.

Methods

We conducted a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Diabetes was defined as a fasting glucose ≥7 mmol/l or non-fasting glucose ≥11.1 mmol/l, self-report of a diagnosis of diabetes by a physician, or current diabetes medication use. Hospitalisation for infection was ascertained from hospital discharge records. Participants were followed from 1987–1989 to 2019.

Results

We included 12,379 participants (mean age 54.5 years; 24.7% Black race; 54.3% female sex). During a median follow-up of 23.8 years, there were 4229 new hospitalisations for infection. After adjusting for potential confounders, people with (vs without) diabetes at baseline had a higher risk for hospitalisation for infection (HR 1.67 [95% CI 1.52, 1.83]). Results were generally consistent across infection type but the association was especially pronounced for foot infection (HR 5.99 [95% CI 4.38, 8.19]). Diabetes was more strongly associated with hospitalisation for infection in younger participants and Black people. Overall infection mortality was low (362 deaths due to infection) but the adjusted risk was increased for people with diabetes (HR 1.72 [95% CI 1.28, 2.31]).

Conclusions/interpretation

Diabetes confers significant risk for infection-related hospitalisation. Enhancing prevention and early treatment of infection in those with diabetes is needed to reduce infection-related morbidity and mortality.

Graphical abstract

中文翻译：

糖尿病和感染住院风险：社区动脉粥样硬化风险 (ARIC) 研究

目标/假设

这项工作的目的是评估糖尿病与感染相关住院和死亡风险之间的关联。

方法

我们对社区动脉粥样硬化风险 (ARIC) 研究进行了前瞻性队列分析。糖尿病被定义为空腹血糖≥7 mmol/l 或非空腹血糖≥11.1 mmol/l，医生自我报告诊断为糖尿病，或当前使用糖尿病药物。根据出院记录确定感染住院情况。从 1987-1989 年到 2019 年对参与者进行了跟踪。

结果

我们纳入了 12,379 名参与者（平均年龄 54.5 岁；24.7% 黑人；54.3% 女性）。在 23.8 年的中位随访期间，有 4229 人因感染而住院。在调整了潜在的混杂因素后，基线时患有（与未患）糖尿病的人因感染而住院的风险更高（HR 1.67 [95% CI 1.52, 1.83]）。不同感染类型的结果基本一致，但足部感染的相关性尤其明显（HR 5.99 [95% CI 4.38, 8.19]）。在年轻参与者和黑人中，糖尿病与感染住院的相关性更强。总体感染死亡率较低（362 人死于感染），但糖尿病患者的调整后风险增加（HR 1.72 [95% CI 1.28, 2.31]）。