Zuag qhia tag nrho thiab ua rau-Specific Mortality nyob rau hauv cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus: Ib tug pej xeem-raws li txoj kev kawm nyob rau hauv Taiwan los ntawm 1998 mus txog 2014

TSAB NTAWV

Keeb kwm: Tshawb nrhiav txhua qhov ua rau thiab ua rau muaj kev tuag tshwj xeeb hauv Taiwanese cov neeg mob ntshav qab zib hom 1.

Txoj Kev: Ib pawg ntawm 17,203 tus neeg mob uas muaj ntshav qab zib hom 1 tau txheeb xyuas los ntawm Taiwan National Health Insurance thov los ntawm 1998 txog 2014. Cov neeg xyoo tau sau rau txhua tus neeg txij li hnub sau npe ntshav qab zib hom 1 mus txog hnub tuag lossis hnub kawg ntawm 2014. Hnub nyoog, poj niam txiv neej, thiab daim ntawv qhia hnub xyoo tus qauv mortality ratios (SMRs) raug xam txog cov pej xeem. Cov txiaj ntsig: Txog li 17 xyoo ntawm kev soj ntsuam, 4,916 tus neeg mob tuag los ntawm 182,523 tus neeg-xyoo. Mob ntshav qab zib mellitus (30.15%), mob qog noj ntshav (20.48%), kab mob ntawm cov hlab ntshav (13.14%), thiabkab mob raum(11.45%) yog qhov ua rau muaj kev tuag. Tus neeg tuag (26.93 rau 1,000 tus neeg-xyoo) los ntawmmob ntshav qab zib hom 1nyob rau hauv Taiwan yog siab, qhov ua rau tuag nrog cov neeg tuag ntau tshaj plaws yog ntshav qab zib (8.12 rau 1,000 tus neeg-xyoo), tom qab ntawd mob qog noj ntshav (5.52 rau 1,000 tus neeg-xyoo), thiab kab mob ntawm cov hlab ntsha (3.54 rau 1,000 tus neeg-xyoo). Tag nrho-ua rau SMR tau nce siab ntawm 4.16 (95% kev ntseeg siab ib ntus, 4.04-4.28), nrog rau qhov ntau dua qhov ua rau SMR sau tseg hauv cov poj niam dua li cov txiv neej (4.62 vs 3.79). Qhov laj thawj tshwj xeeb SMR tau nce siab rau cov ntshav qab zib (SMR, 16.45), tom qab ntawdmob raum(SMR, 14.48).mob kab mob siabthiabdaim siab cirrhosis(SMR, 4.91), thiab kab mob (SMR, 4.59). Txhua qhov ua rau SMRs kuj tau nce ntxiv rau txhua lub hnub nyoog, nrog rau daim duab loj tshaj plaws tau sau tseg rau 15-24 xyoo (SMR, 8.46).

Cov lus xaus:Mob ntshav qab zib hom 1Nyob rau hauv ob leeg poj niam txiv neej thiab tag nrho cov hnub nyoog yog txuam nrog loj SMRs rau tag nrho cov ua rau thiab feem ntau rau cov ntshav qab zib ib se thiab raum kab mob.

Ntsiab lus:kev tshawb fawb sib koom ua ke; kev tuag; standardized mortality ratio;mob ntshav qab zib hom 1;lub hauv paus ua rau tuag

Cistanche ntxiv rau raum Kev Txhawb Nqa Ntxiv PhGs75% Ech 30% Txoj Cai 12%

Taw qhia

Mob ntshav qab zib hom 1mellitusmuaj feem cuam tshuam nrog kev pheej hmoo ntawm kev tuag ntxov ntxov los ntawm ntau yam mob hnyav thiab mob ntev.1–3 Kev tuag ntawm cov menyuam yaus thiab cov hluas uas muaj ntshav qab zib hom 1 feem ntau cuam tshuam nrog kev mob ntshav qab zib mob hnyav; lub caij no, lub ntsiab ua rau tuag nyob rau hauv cov neeg laus muaj feem xyuam rau cov teeb meem mus sij hawm ntev, tshwj xeeb tshaj yogkab mob plawv(CVD).4,5 Txawm hais tias muaj kev pheej hmoo ntawm kev tuag ntawm cov tib neeg nrogmob ntshav qab zib hom 1tseem nce siab, ib qho kev poob qis hauv kev tuag ntawm cov neeg mob ntshav qab zib hom 1 tau pom nyob rau ntau qhov chaw hauv ntiaj teb, xws li Norway, Australia, thiab Sweden.6-8 Ib qho kev ntsuam xyuas ntawm covtxheeb ze kev pheej hmoo (RR) ntawm kev tuag rau hom 1 mob ntshav qab zibpiv nrog rau cov pej xeem uas suav nrog 26 kev tshawb fawb nrog 88 sub-populations pom tias tag nrho RR ntawm kev tuag yog 3.82 (95% kev ntseeg siab interval [CI], 3.41–4.29) piv nrog cov pej xeem.9 Kev soj ntsuam siv cov ntaub ntawv ua ntej 1971 muaj ib tug Qhov loj dua kwv yees RR (5.80) thaum piv nrog cov ntaub ntawv ntawm 1971 thiab 1980 (RR 5.06), 1981–1990 (RR 3.59), thiab cov tom qab 1990 (RR 3.11). Kev txhim kho kev tuag tsis ntev los no los ntawm hom 1 mob ntshav qab zib mellitus feem ntau yog los ntawm kev tswj hwm cov txheej txheem uas hais txog kev tswj glycemic nruj,tswj ntshav siab, thiabkev kho mob ntawm dyslipidemia, nrog rau kev haus luam yeeb, hauv kev tswj hwm ntawmyam 1ntshav qab zib.10–12

Cov pov thawj tsis ntev los no qhia txog kev txo qis hauv kev tuag los ntawmmob ntev,8 tab sis me ntsis kev hloov pauv hauv kev tuag los ntawm cov teeb meem mob hnyav ntawm hom 1 mob ntshav qab zib mellitus.13 Kev tuag sib txawv ntawm cov teb chaws, 4, thiab cov teb chaws uas muaj cov mob ntshav qab zib hom 1 qis dua muaj qhov tseeb thiab cov txheeb ze tuag ntau dua li cov teb chaws muaj ntau dua.6,14 Willi et al15 qhia txog kev sib txawv ntawm haiv neeg hauv cov txiaj ntsig ntawm cov menyuam yaus uas muaj ntshav qab zib hom 1, nrog rau cov neeg koom nrog dub muaj ntshav qab zib ketoacidosis ntau dua thiab cov xwm txheej hypoglycemic hnyav dua li cov neeg koom nrog dawb lossis neeg Mev. Kev tshuaj xyuas tsis ntev los no tau txheeb xyuas 16 qhov kev tshawb fawb uas pom tias haiv neeg tsawg= cov tub ntxhais hluas haiv neeg tsawg uas muaj ntshav qab zib hom 1 muaj hemoglobin A1c (HbA1c) ntau dua li cov tub ntxhais hluas Caucasian.16 Kev tshuaj xyuas tsis ntev los no tau qhia tias South Asian haiv neeg uas muaj ntshav qab zib hom 1 muaj kev tuag ntau dua. Cov neeg European dawb vim yog CVD ntau dhau. Hom 1 mob ntshav qab zib mellitus hauv South Asians kuj tseem muaj HbA1c siab dua, qis dua lipoprotein ntom ntom, thiab qis dua cov kab mob neuropathy dua li cov neeg European dawb.17

Hauv Taiwan, qhov tshwm sim txhua xyoo ntawm cov menyuam yaus (<15 years) type 1 diabetes was stable for boys and girls, with a mean annual incidence rate of 5.3 per 100,000 children between 2003 and 2008.18,19 Compared with Western countries, especially the Nordic nations, Taiwan is among the nations with a low incidence rate of type 1 diabetes. However, the mortality of individuals with type 1 diabetes in Taiwan has not been adequately studied. This study aimed to investigate the overall, sex-specific, and age-specific risks of mortality from all-cause and various causes among type 1 diabetes patients in 1998–2014.

Txoj kev

Txoj kev tshawb fawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb ntawm National Cheng Kung University Tsev Kho Mob (No. B-EX- 105-010). Daim ntawv tso cai pom zoo raug zam vim qhov kev lees paub ntawm tus kheej.

Cov ntaub ntawv

Cov ntaub ntawv txheeb xyuas hauv qhov kev tshawb fawb no tau muab los ntawm cov ntaub ntawv ntawm National Health Insurance (NHI) program thiab Taiwan Death Registry (TDR) los ntawm 1998 txog 2014. NHI thov cov ntaub ntawv khaws cov ntaub ntawv kho mob hauv tsev kho mob thiab cov neeg mob sab nraud ntawm txhua tus neeg nyob hauv Taiwan, thiab NHI. Cov thawj coj ua kev tshuaj xyuas cov kws tshaj lij peb lub hlis twg ntawm ib qho piv txwv ntawm cov ntawv thov kho mob kom ntseeg tau tias lawv raug.20 Peb tau siv ntau qhov chaw ntawm NHI thov cov ntaub ntawv, suav nrog Cov Ntaub Ntawv Kev Mob Ntsws Zoo (CID) thiab Cov Neeg Tau Txais Kev Sau Npe uas suav nrog cov yam ntxwv ntawm txhua tus neeg. Cov ntaub ntawv hais txog kev kuaj mob ntshav qab zib hom 1 yog ntawm cov kab mob loj heev hauv CID. Cov tib neeg uas tau sau npe hauv CID rau hom 1 mob ntshav qab zib yuav tsum tau tshaj tawm rau NHIA lub rooj saib xyuas tus kws kho mob daim ntawv pov thawj kuaj mob thiab cov ntaub ntawv kho mob cuam tshuam, suav nrog cov txiaj ntsig kev kuaj mob, yoo mov lossis glucagon-stimulated qib C-peptide, qib anti-GAD antibody, thiab keeb kwm ntawm mob ntshav qab zib ketoacidosis. Kev kuaj mob ntshav qab zib hom 1 hauv CID yav dhau los tau siv los qhia txog qhov tshwm sim ntawm hom 1 mob ntshav qab zib hauv Taiwan.18,19 nrog qhov kev kwv yees zoo ntawm 98.3%.19 Hauv Taiwan, txhua tus neeg yug thiab tuag yuav tsum tau sau npe hauv 10 hnub tom qab yug. los yog kev tuag raws li kev cai lij choj. Daim ntawv pov thawj kev tuag muaj ntau yam ntaub ntawv, suav nrog cov pej xeem sib txawv, qhov ua rau tuag (UCOD), qhov chaw tuag, thiab kev txij nkawm. Cov ntaub ntawv zoo rau TDR tau raug tshuaj xyuas thiab suav tias yog siv tau thiab ua tiav.21

Txoj kev tsim qauv Peb tau siv cov qauv kev tshawb fawb rov qab uas tau pib suav nrog 17,269 tus neeg mob ntshav qab zib hom 1 uas tau sau npe nrog CID thaum xyoo 1998 thiab 2014. Tom qab tsis suav nrog 66 tus neeg mob uas tsis muaj ntaub ntawv qhia txog poj niam los yog hnub nyoog ntawm CID sau npe, txoj kev tshawb no tau tso npe rau 17,203 txoj kev kawm. Hnub ntawm kev sau npe CID raug suav tias yog hnub ntawm kev sau npe kawm hauv pawg neeg (piv txwv li, pawg neeg nkag).

Cov neeg mob txoj kev tshawb fawb tau txuas nrog TDR siv tus lej cim tus kheej tshwj xeeb los txheeb xyuas cov neeg mob uas tuag thaum lub sijhawm kawm xyoo 1998-2014. Cov ntaub ntawv ntawm UCOD yog raws li International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) (1998–2007) lossis Kaum Ib Hlis (ICD-10-CM) (2008–2014) cov lej. Hauv 17 xyoo ntawm kev soj ntsuam, 4,916 tus neeg tuag, suav nrog 2,511 txiv neej thiab 2,405 tus poj niam.

Kev txheeb cais

Cov neeg-xyoo tau soj ntsuam rau txhua qhov kev kawm tau sau los ntawm hnub ntawm kev sau npe koom nrog rau hnub tuag lossis hnub kawg ntawm 2014. Hnub nyoog ntawm kev cuv npe tau muab faib ua 0–14, 15–29, 30–44, thiab Ntau dua lossis sib npaug rau 45 xyoo. Tus neeg-xyoo tau muab faib raws li xyoo, poj niam txiv neej, thiab tus neeg mob lub hnub nyoog ntawm cov xyoo sib txawv (ie, ua ntej 2003, 2003-2006, 2007-2010, thiab 2011-2014). Cov pab pawg tshawb fawb tau pab 182,523 tus neeg-xyoo nyob rau lub sijhawm taug qab. Cov neeg tuag tau raug xam raws li tus naj npawb ntawm cov neeg tuag muab faib los ntawm cov neeg soj ntsuam-xyoo. Ciaj sia taus nkhaus rau kev sib deev-stratified thiab hnub nyoog-stratified cumulative survival kev pheej hmoo tau npaj siv Kaplan-Meier cov khoom txwv txoj kev thiab muab piv nrog kev ntsuas ntsuas ntsuas. Peb muab piv rau cov neeg mob qhov kev pheej hmoo ntawm txhua qhov ua rau thiab qhov ua rau tuag rau cov neeg ntawm cov pej xeem uas sib piv nrog poj niam txiv neej thiab hnub nyoog ntawm cov xyoo tshwj xeeb. UCOD soj ntsuam hauv qhov kev tshawb fawb no suav nrog ntshav qab zib, kab mob hauv lub cev, mob qog noj ntshav, mob raum, mob hnyav thiab kev raug mob, tua tus kheej, kis kab mob, kab mob siab ntev lossis mob siab cirrhosis, thiab kab mob ntsws ntev (COPD). eTable 1 qhia cov lej rau cov xaiv UCOD txheeb xyuas hauv qhov kev tshawb fawb no. Qhov xav tias muaj pes tsawg tus neeg tuag rau hom 1 mob ntshav qab zib hom 1 tau suav los ntawm tus neeg-xyoo mus kom ze uas siv cov hnub nyoog thiab poj niam txiv neej cov neeg tuag txhua xyoo, hais txog cov pej xeem ntawm Taiwan. Cov hnub nyoog txhua xyoo- thiab cov poj niam txiv neej qhov loj me rau cov pej xeem nyob rau lub sijhawm kawm tau muab los ntawm lub teb chaws txhua xyoo kev sau npe tsev neeg cov ntaub ntawv luam tawm los ntawm Ministry of Interior of Taiwan. Qhov nruab nrab txhua xyoo ntawm cov pejxeem nyob rau lub sijhawm kawm (piv txwv li, 1998-2014) yog 23,769,198. Zuag qhia tag nrho, kev sib deev tshwj xeeb, thiab hnub nyoog tshwj xeeb tus qauv kev tuag tus qauv (SMRs) raug xam. 95% CI rau SMR tau kwv yees siv qhov kev kwv yees.22 Cov kev faib tawm ntawm UCOD tau nthuav tawm raws li hnub nyoog ntawm kev cuv npe, poj niam txiv neej, thiab xyoo ntawm kev sib koom ua ke. Kev tshuaj xyuas tau ua tiav siv SAS (version 9.4; SAS Institute, Cary, NC, USA), thiab theem ntawm qhov tseem ceeb tau teeb tsa ntawm=0.05.