Abstract
BackgroundStudies have suggested sex differences in the mortality rate associated with diabetes. We conducted a meta-analysis to estimate the relative effect of diabetes on the risk of all-cause, cancer, cardiovascular disease (CVD), infectious disease, and respiratory disease mortality in women compared with men.MethodsStudies published from their inception to April 1, 2018, identified through a systematic search of PubMed and EMBASE and review of references. We used the sex-specific RRs to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random-effects meta-analysis weighted by the inverse of the variances of the log RRRs.ResultsForty-nine studies with 86 prospective cohorts met the inclusion criteria and were eligible for analysis. The pooled women-to-men RRR showed a 13% greater risk of all-cause mortality associated with diabetes in women than in men (RRR 1.13, 95% CI 1.07 to 1.19; P < 0.001). The pooled multiple-adjusted RRR indicated a 30% significantly greater excess risk of CVD mortality in women with diabetes compared with men (RRR 1.30, 95% CI 1.13 to 1.49; P < 0.001). Compared with men with diabetes, women with diabetes had a 58% greater risk of coronary heart disease (CHD) mortality, but only an 8% greater risk of stroke mortality (RRRCHD 1.58, 95% CI 1.32 to 1.90; P < 0.001; RRRstroke 1.08, 95% CI 1.01 to 1.15; P < 0.001). However, no sex differences were observed in pooled results of populations with or without diabetes for all-cancer (RRR 1.02, 95% CI 0.98 to 1.06; P = 0.21), infectious (RRR 1.13, 95% CI 0.90 to 1.38; P = 0.33), and respiratory mortality (RRR 1.08, 95% CI 0.95 to 1.23; P = 0.26).ConclusionsCompared with men with the same condition, women with diabetes have a 58% and 13% greater risk of CHD and all-cause mortality, respectively, although there was a significant heterogeneity between studies. This points to an urgent need to develop sex- and gender-specific risk assessment strategies and therapeutic interventions that target diabetes management in the context of CHD prevention.
Highlights
Studies have suggested sex differences in the mortality rate associated with diabetes
Through internal, within-study comparisons of female and male participants, have observed that women with diabetes are at substantially higher risk of coronary heart disease (CHD), stroke, and gastric cancer compared to affected men
Study selection Studies were included if they met the following criteria: (1) the study was a prospective cohort design; (2) the outcomes included all-cause mortality, cancer mortality, cardiovascular disease (CVD) mortality, CHD mortality, stroke mortality, infectious disease mortality, and/or respiratory disease mortality; (3) the studies provided odds ratio (OR), relative risk (RR), or hazard ratio (HR) with 95% confidence intervals (CI) for the associations between diabetes and mortality disaggregated for men and women participants; and (4) when multiple publications reported on the same population or subpopulation, the study with the most recent or most informative data was included
Summary
Studies have suggested sex differences in the mortality rate associated with diabetes. The magnitude of the excess risk of these and other cause-specific outcomes that are conferred by diabetes for men and women is unknown It is unclear whether important confounders (e.g., age) and methodological heterogeneity (duration of follow-up, method of diabetes classification or assessment) would modify any such sex differential in the association between diabetes and mortality. It is unclear whether such a difference might be more pronounced in recent years with the growing obesity epidemic (e.g., year of publication)
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