Trends of diabetic nephropathy prevalence in Isfahan, Iran, during 1992-2010

Cause-Specific Risk Factors of Death in Individuals with Diabetes: A Competing Risks Modeling

BACKGROUND

Diabetes is on the rise worldwide.

OBJECTIVES

This study aimed to evaluate the risk factors of various causes of death in people with type 2 diabetes (T2D).

METHODS

In this cohort study on 2638 people with T2D, we applied cause-specific and sub-distribution hazards models to assess the impact of various factors on the risk of death. Moreover, we plotted a cumulative incidence curve to summarize cumulative failure rates over time.

RESULTS

About 75% of individuals with T2D died from cardiovascular disease (CVD) and cerebrovascular accidents (CVA). Death from CVD was associated with the increased risk of hypertension (hazard ratio (HR) = 1.83, 95% CI: 1.37 - 2.46), hypercholesterolemia (HR = 1.58, 95% CI: 1.17 - 2.14), and diabetes duration. The risk of death from CVA was related to hypertension (HR = 2.76, 95% CI: 1.67 - 4.55) and hyperglycemia (HR = 4.34, 95% CI: 1.75 - 10.79). The CVA risk in patients with diabetes duration of 10 - 20 years was higher than the risk in patients with diabetes duration > 20 years (diabetes duration of ≤ 10 years as the reference category). Diabetes duration of longer than 20 years was associated with a higher risk of death from cancer (HR = 2.65, 95% CI: 1.05 - 6.68). The risk of death from foot infection and diabetic nephropathy increased in patients with longer diabetes duration after adjustment for sex, age, and body mass index.

CONCLUSIONS

Regardless of the cause, death rates in people with T2D increase over time and risk factors have different impacts on death from each cause. This should be acknowledged in risk management in individuals with T2D.

Epidemiologic Trend of Smear-Positive, Smear-Negative, Extra Pulmonary and Relapse of Tuberculosis in Iran (2001-2015); A Repeated CrossSectional Study

Background: Trend analysis is an important tool to monitor epidemiological changes of disease over time to guide resource allocation. This study aimed to study incidence trends and change-points of smear positive, smear negative, extra-pulmonary and relapse of tuberculosis (TB) in Iran from 2001 to 2015.

Study design: Repeated cross-sectional study

Methods:Nonlinear segmented regression w as used to describe TB incidence trends; annual percent change (APC), average annual percent changes (AAPC) and change points for each disease separately.

Results: Of 154930 TB cases, 49.8% w ere smear positive, 19.7% smear negative, 27.32% extrapulmonary and 3.18% relapse. For all TB types, the peak of incidence w as in 2001. Tw o change point w ere estimated for all TB types (P<0.05). The APC of all TB types w ere -6.51 (95% CI: -7.4, -5.4) for first and 2.4 (95% CI: 0. 7, 4.1) for second segment. Although the trends w ere significantly decreasing from 2001 to 2015 for smear positive (AAPC=2.06%), smear negative (AAPC=3.57%), extra pulmonary (AAPC=3.2%) and relapse (AAPC=3.3%), the AAPCs of trends w ere not significant from 2006 to 2015. Except for Extra pulmonary TB (APC=4-.9%, 95%CI:-10, 1.2), the APCs of the last segments w ere significant.

Conclusions:Even though the TB incidence rates w ere decreasing, the amount of reductions seem inadequate, to reach the goals of TB control in Iran. Especially, the increase in the extra-pulmonary TB rates is a point of concern that highlights more attention is required for these cases. It is essential to improve economic supports tow ard TB control, illegal immigrants, data registry systems and physician's sensitivity in TB detection.