Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters

Type 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association betwee...

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Autores: Tebé, Cristian, Martínez-Laguna, Daniel, Moreno, Víctor, Cooper, Cyrus, Diez-Perez, Adolfo, Collins, Gary S., Prieto-Alhambra, Daniel
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2018
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/35841
Acceso en línea:http://hdl.handle.net/10230/35841
http://dx.doi.org/10.1002/jbmr.3435
Access Level:acceso abierto
Palabra clave:Diabetis
Fractures
Osteoporosi
Epidemiologia
Competing risk
Epidemiology
Fracture risk assessment
Osteoporosis
Type 2 diabetes mellitus
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spelling Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction mattersTebé, CristianMartínez-Laguna, DanielMoreno, VíctorCooper, CyrusDiez-Perez, AdolfoCollins, Gary S.Prieto-Alhambra, DanielDiabetisFracturesOsteoporosiEpidemiologiaCompeting riskEpidemiologyFracture risk assessmentOsteoporosisType 2 diabetes mellitusType 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association between T2DM and hip fracture rates. Participants were all diagnosed T2DM patients registered in the Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) database aged 65 years and older; up to two non-T2DM were matched by age, sex, and primary care facility. We used Cox regression models to estimate cause-specific hazard ratio (HR) of death or hip fracture according to T2DM status. Fine and Gray models were then fitted to estimate the subhazard ratio (SHR) of hip fracture while accounting for competing risk with death and to estimate the probability of hip fracture within 5 years. A total of 55,891 T2DM and 103,093 matched non-T2DM patients were observed for a median of 8 years. Mortality was 48.8 per 1000 person years (py) in T2DM, and 33.8 per 1000 py in non-T2DM; hip fracture rates were 6.0 per 1000 py and 4.9 per 1000 py, respectively. Cox models confirmed a significant association for death and hip fracture: HR 1.51 (95% CI, 1.48 to 1.55), and HR 1.32 (95% CI, 1.24 to 1.40), respectively. Accounting for death as a competing event (Fine-Gray models), the association between T2DM and hip fracture risk remained statistically significant (SHR 1.15; 95% CI, 1.09 to 1.21) and the probability of a hip fracture within 5 years was 2.3% for TD2M and 1.9% for non-TD2M patients compared to 2.6% and 2.1% respectively using Kaplan-Meier (KM) estimates. T2DM patients have a 50% increased mortality and, after adjusting for differential survival at 5 years, a 21% increased incidence of hip fracture when compared to matched non-T2DM. Failing to account for differential mortality leads to an overestimation of fracture risk.Wiley20182018info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/35841http://dx.doi.org/10.1002/jbmr.3435reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésJournal of Bone and Mineral Research. 2018 Aug;33(8):1417-21This is the peer reviewed version of the following article:ebé C, Martinez-Laguna D, Moreno V, Cooper C, Diez-Perez A, Collins GS. Et al. Differential Mortality and the Excess Rates of Hip Fracture Associated With Type 2 Diabetes: Accounting for Competing Risks in Fracture Prediction Matters. J Bone Miner Res. 2018 Aug;33(8):1417-1421, which has been published in final form at http://dx.doi.org/10.1002/jbmr.3435. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.info:eu-repo/semantics/openAccessoai:recercat.cat:10230/358412026-05-29T05:05:01Z
dc.title.none.fl_str_mv Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
title Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
spellingShingle Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
Tebé, Cristian
Diabetis
Fractures
Osteoporosi
Epidemiologia
Competing risk
Epidemiology
Fracture risk assessment
Osteoporosis
Type 2 diabetes mellitus
title_short Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
title_full Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
title_fullStr Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
title_full_unstemmed Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
title_sort Differential mortality and the excess rates of hip fracture associated with Type 2 Diabetes: accounting for competing risks in fracture prediction matters
dc.creator.none.fl_str_mv Tebé, Cristian
Martínez-Laguna, Daniel
Moreno, Víctor
Cooper, Cyrus
Diez-Perez, Adolfo
Collins, Gary S.
Prieto-Alhambra, Daniel
author Tebé, Cristian
author_facet Tebé, Cristian
Martínez-Laguna, Daniel
Moreno, Víctor
Cooper, Cyrus
Diez-Perez, Adolfo
Collins, Gary S.
Prieto-Alhambra, Daniel
author_role author
author2 Martínez-Laguna, Daniel
Moreno, Víctor
Cooper, Cyrus
Diez-Perez, Adolfo
Collins, Gary S.
Prieto-Alhambra, Daniel
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Diabetis
Fractures
Osteoporosi
Epidemiologia
Competing risk
Epidemiology
Fracture risk assessment
Osteoporosis
Type 2 diabetes mellitus
topic Diabetis
Fractures
Osteoporosi
Epidemiologia
Competing risk
Epidemiology
Fracture risk assessment
Osteoporosis
Type 2 diabetes mellitus
description Type 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association between T2DM and hip fracture rates. Participants were all diagnosed T2DM patients registered in the Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) database aged 65 years and older; up to two non-T2DM were matched by age, sex, and primary care facility. We used Cox regression models to estimate cause-specific hazard ratio (HR) of death or hip fracture according to T2DM status. Fine and Gray models were then fitted to estimate the subhazard ratio (SHR) of hip fracture while accounting for competing risk with death and to estimate the probability of hip fracture within 5 years. A total of 55,891 T2DM and 103,093 matched non-T2DM patients were observed for a median of 8 years. Mortality was 48.8 per 1000 person years (py) in T2DM, and 33.8 per 1000 py in non-T2DM; hip fracture rates were 6.0 per 1000 py and 4.9 per 1000 py, respectively. Cox models confirmed a significant association for death and hip fracture: HR 1.51 (95% CI, 1.48 to 1.55), and HR 1.32 (95% CI, 1.24 to 1.40), respectively. Accounting for death as a competing event (Fine-Gray models), the association between T2DM and hip fracture risk remained statistically significant (SHR 1.15; 95% CI, 1.09 to 1.21) and the probability of a hip fracture within 5 years was 2.3% for TD2M and 1.9% for non-TD2M patients compared to 2.6% and 2.1% respectively using Kaplan-Meier (KM) estimates. T2DM patients have a 50% increased mortality and, after adjusting for differential survival at 5 years, a 21% increased incidence of hip fracture when compared to matched non-T2DM. Failing to account for differential mortality leads to an overestimation of fracture risk.
publishDate 2018
dc.date.none.fl_str_mv 2018
2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/35841
http://dx.doi.org/10.1002/jbmr.3435
url http://hdl.handle.net/10230/35841
http://dx.doi.org/10.1002/jbmr.3435
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Journal of Bone and Mineral Research. 2018 Aug;33(8):1417-21
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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