Uzroci smrti osoba sa šećernom bolešću u Republici Hrvatskoj [Causes of death in persons with diabetes mellitus in Croatia]

Šekerija, Mario (2013) Uzroci smrti osoba sa šećernom bolešću u Republici Hrvatskoj [Causes of death in persons with diabetes mellitus in Croatia]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The hypothesis of this dissertation was that diabetes mellitus is insufficiently recognized as a cause of death and that, in deceased persons in Croatia, it is mentioned on death certificates three times more often than it is coded as an underlying cause of death. It was also hypothesized that, in deceased persons with previously diagnosed diabetes mellitus, diabetes is rarely mentioned as an underlying cause of death and that it is mentioned on less than a half of those death certificates. The aims of this dissertation were to establish the recognition of diabetes on death certificates in the general population both as the underlying cause of death and one of the multiple causes of death; to explore the causes of death in persons with diagnosed diabetes mellitus (from the CroDiab registry) in Croatia; and to establish the factors that are associated with more frequent citing of diabetes as one of the causes of death, both in the general population and in the population of persons with diabetes from the CroDiab registry. In the first part of the study, death certificates for all deceased persons in Croatia for the year 2010 were examined (N=52,096). Based on this data, mortality fractions for diabetes as underlying cause of death and as one of multiple causes of death were established. In the second part of the study, these data were combined with data on the cohort of persons with diabetes from the CroDiab registry (N=66,329). The causes of death for persons with diabetes who had deceased in 2010 were established (N=2,593, crude mortality rate 3,909/100,000), as were the proportion of death certificates mentioning diabetes in these patients, and the factors associated with citing diabetes on these death certificates. The data on the frequency of reporting of diabetes on death certificates and the causes of death were presented by descriptive statistics. The prediction of citing of diabetes on death certificates and the factors of risk were determined by bivariate and multivariate logistic regression models. In the general population, diabetes was recognized as the underlying cause of death in 3% of deceased women and 2.5% of deceased men (p<0.001), and as one of multiple causes of death in 12.3% of deceased women and 10.6% of deceased men (p<0.001). The odds of diabetes appearing on the death certificate were 7% higher in women, 13% higher if death had occurred in a health institution, and 51% lower if the cause of death was determined by a pathologist. Diabetes was the underlying cause of death in 14.9% of deceased persons with diabetes mellitus (without sex differences), and the most common cause of death in these persons were cardiovascular diseases (48.4%). Among all deceased persons with diabetes from the CroDiab registry, diabetes was cited on 51.8% of death certificates (without sex differences). In the multivariate model, significant predictors were the cause of death assigned by a pathologist (60% lesser odds) and diabetes duration longer than 15 years (89% greater odds). In conclusion, diabetes is recognized as the underlying cause of death in one in seven persons with diabetes, and it is recognized as one of multiple causes of death in just above one half of all deaths in persons with diabetes. Therefore, the reliance on official mortality statistics significantly underestimates the burden of diabetes in Croatia, which should be taken into consideration when planning population-based public health interventions. The official mortality statistics in Croatia is still based on the underlying causes of death only, which significantly underestimates the burden of disease associated with certain diseases that are often mentioned as one of the multiple causes of death, such as diabetes. Therefore, the implementation of mortality statistics coding system which codes multiple causes of death should be considered. This system, operating in many European countries, provides a better insight in the public health importance and mortality fractions attributable to various diseases, including diabetes.

Abstract in Croatian

Hipoteza ove disertacije bila je da je šećerna bolest slabo prepoznata kao uzrok smrti te se spominje kao jedan od višestrukih uzroka smrti u tri puta više umrlih osoba nego što je navedeno u službenim statistikama koje se zasnivaju samo na osnovnom uzroku smrti. Također, hipoteza je bila da se u umrlih osoba s prethodno dijagnosticiranom šećernom bolešću ona rijetko navodi kao uzrok smrti te je prepoznata kao jedan od višestrukih uzroka smrti u manje od polovice umrlih osoba s dijabetesom u Hrvatskoj. Ciljevi disertacije su bili odrediti prepoznatost dijabetesa na potvrdama o smrti u općoj populaciji kao osnovnog uzroka smrti i jednog od višestrukih uzroka smrti; istražiti uzroke smrti i prepoznatost šećerne bolesti kao uzroka smrti u osoba s prethodno poznatom šećernom bolešću (iz CroDiab registra) u Hrvatskoj; te odrediti čimbenike koji su povezani s češćim navođenjem dijabetesa kao jednog od uzroka smrti u općoj populaciji i u populaciji osoba sa šećernom bolešću zabilježenih u CroDiab registru. U prvom dijelu istraživanja pregledane su potvrde o smrti za sve preminule osobe u Hrvatskoj 2010. godine (N=52.096). Na temelju tih podataka su određeni mortalitetni udjeli šećerne bolesti kao osnovnog uzroka smrti i kao jednog od višestrukih uzroka smrti. U drugom dijelu istraživanja su ovi podaci upareni s podacima o kohorti osoba sa šećernom bolešću iz CroDiab registra (N=66.329). Tako su utvrđeni uzroci smrti u osoba sa šećernom bolešću preminulih 2010. godine (N=2.593, gruba stopa mortaliteta 3.909/100.000), udjeli prepoznatog dijabetesa na potvrdama o smrti u ovih bolesnika te čimbenici povezani s navođenjem dijabetesa na potvrdama o smrti u bolesnika s poznatom šećernom bolešću. Podaci o zastupljenosti dijabetesa na potvrdama o smrti i uzroci smrti prikazani su metodama deskriptivne statistike, dok su za predikciju pojavnosti dijabetesa na potvrdama o smrti i određivanje čimbenika rizika korišteni bivarijatni i multivarijatni modeli logističke regresije. U općoj populaciji je šećerna bolest bila osnovni uzrok smrti u 3% umrlih žena i 2,5% umrlih muškaraca (p<0,001), a bila je jedan od višestrukih uzroka smrti u 12,3% umrlih žena i 10,6% umrlih muškaraca (p<0,001). Šansa za pojavu dijabetesa na potvrdi o smrti je bila 7% veća kod žena, 13% veća ukoliko je smrt nastupila u zdravstvenoj ustanovi, te 51% manja ukoliko je uzrok smrti odredio obducent. Dijabetes je bio osnovni uzrok smrti u 14,9% preminulih osoba sa šećernom bolešću (bez razlika po spolu), a najčešći uzrok smrti u ovoj skupini bolesnika su bile kardiovaskularne bolesti (48,4%). Među svim preminulim osobama iz CroDiab registra, šećerna bolest je bila navedena u 51,8% potvrda o smrti (bez razlika po spolu). U multivarijatnom modelu značajni prediktori su bili određivanje uzroka smrti od strane obducenta (60% manja šansa) i trajanje dijabetesa duže od 15 godina (89% veća šansa). Zaključno, šećerna bolest je prepoznata kao osnovni uzrok smrti svake sedme oboljele osobe te je prepoznata kao jedan od višestrukih uzroka tek u nešto više od polovice svih smrtnih ishoda u osoba sa šećernom bolešću. U skladu s time, oslanjanje na podatke službene mortalitetne statistike značajno podcjenjuje opterećenje bolešću uzrokovano dijabetesom u Hrvatskoj, što je potrebno uzeti u obzir pri planiranju intervencija na razini populacije. Službena mortalitetna statistika u Hrvatskoj se još uvijek zasniva samo na osnovnim uzrocima smrti, što podcjenjuje javnozdravstveni značaj bolesti koje su često navedene kao jedan od uzroka smrti, poput šećerne bolesti. Zbog ovoga bi se trebalo razmisliti o uvođenju sustava mortalitetne statistike koji bilježi više uzroka smrti. Takav sustav, koji je u funkciji u velikom broju europskih država, omogućuje bolji uvid u javnozdravstveni značaj i mortalitetni udio pripisiv pojedinim bolestima, uključujući i šećernu bolest.

Item Type: Thesis (PhD)
Mentors:
Mentor
Metelko, Željko
Departments: Izvan medicinskog fakulteta
Depositing User: dr.med. Helena Markulin
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 88
Status: Unpublished
Creators:
CreatorsEmail
Šekerija, MarioUNSPECIFIED
Date: 13 June 2013
Date Deposited: 01 Feb 2017 10:11
Last Modified: 01 Feb 2017 10:11
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/2640

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