Abstract
BackgroundThere remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age.MethodsAll patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes).ResultsIn 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27–1.37) in women vs. 1.12(1.08–1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16–1.19) in women vs. 1.10(1.09–1.12) in men for type 2 diabetes.ConclusionAlthough men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.
Highlights
Atrial fibrillation (AF) and diabetes mellitus are common worldwide and their incidence is increasing, representing a significant public health and economic burden as well as an increase in individual risk of morbidity and mortality
We further investigate these issues and performed a nationwide longitudinal cohort study to examine whether diabetes confers higher relative rates of atrial fibrillation (AF) in women compared to men, and whether these sex-differences depend on type of diabetes and age
Use of medication was identified from a 1/97 permanent random sample of the complete French nationwide claims database (Echantillon Généraliste de Bénéficiaires, EGB – general sample of healthcare beneficiaries), which is another database not linked to the Programme de Médicalisation des Systèmes d’Information (PMSI) database but has been previously used to study patients with diabetes in France [17]) We report information for patients with same inclusion criteria than those in the present analysis
Summary
Atrial fibrillation (AF) and diabetes mellitus are common worldwide and their incidence is increasing, representing a significant public health and economic burden as well as an increase in individual risk of morbidity and mortality. Both conditions are closely related, and AF patients with diabetes are at higher risk of cardiovascular events. There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age
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