Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission

Sarah H Wild (Lead / Corresponding author), Jeremy J Walker, Joanne R Morling, David A McAllister, Helen M Colhoun, Bassam Farran, Stuart McGurnaghan, Rory McCrimmon, Stephanie H Read, Naveed Sattar, Christopher D Byrne, Scottish Diabetes Research Network Epidemiology Group

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Abstract

Objective: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM).

Research Design and Methods: We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people ages 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and -10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors.

Results: A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality.

Conclusions: Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.

Original languageEnglish
Article numberdc171590
Pages (from-to)341-347
Number of pages7
JournalDiabetes Care
Volume41
Issue number2
Early online date22 Nov 2017
DOIs
Publication statusPublished - Feb 2018

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Alcoholic Fatty Liver
Alcoholic Liver Diseases
Type 2 Diabetes Mellitus
Hospital Records
Cardiovascular Diseases
Mortality
Liver Diseases
International Classification of Diseases
Neoplasms
Death Certificates
Scotland
Proportional Hazards Models
Registries
Hepatocellular Carcinoma
Cohort Studies
Research Design
Retrospective Studies
Non-alcoholic Fatty Liver Disease
Carcinoma
Population

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular/complications
  • Cardiovascular Diseases/epidemiology
  • Diabetes Complications/epidemiology
  • Diabetes Mellitus, Type 2/complications
  • Female
  • Hospitalization/statistics & numerical data
  • Humans
  • Liver Diseases, Alcoholic/complications
  • Liver Neoplasms/complications
  • Male
  • Middle Aged
  • Mortality
  • Neoplasms/epidemiology
  • Non-alcoholic Fatty Liver Disease/complications
  • Patient Admission/statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Scotland/epidemiology

Cite this

Wild, S. H., Walker, J. J., Morling, J. R., McAllister, D. A., Colhoun, H. M., Farran, B., ... Scottish Diabetes Research Network Epidemiology Group (2018). Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. Diabetes Care, 41(2), 341-347. [dc171590]. https://doi.org/10.2337/dc17-1590
Wild, Sarah H ; Walker, Jeremy J ; Morling, Joanne R ; McAllister, David A ; Colhoun, Helen M ; Farran, Bassam ; McGurnaghan, Stuart ; McCrimmon, Rory ; Read, Stephanie H ; Sattar, Naveed ; Byrne, Christopher D ; Scottish Diabetes Research Network Epidemiology Group. / Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. In: Diabetes Care. 2018 ; Vol. 41, No. 2. pp. 341-347.
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title = "Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission",
abstract = "Objective: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM).Research Design and Methods: We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people ages 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and -10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors.Results: A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95{\%} CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality.Conclusions: Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.",
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author = "Wild, {Sarah H} and Walker, {Jeremy J} and Morling, {Joanne R} and McAllister, {David A} and Colhoun, {Helen M} and Bassam Farran and Stuart McGurnaghan and Rory McCrimmon and Read, {Stephanie H} and Naveed Sattar and Byrne, {Christopher D} and {Scottish Diabetes Research Network Epidemiology Group}",
note = "Data linkage was funded by the Scottish Government through the Scottish Diabetes Group.",
year = "2018",
month = "2",
doi = "10.2337/dc17-1590",
language = "English",
volume = "41",
pages = "341--347",
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issn = "0149-5992",
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Wild, SH, Walker, JJ, Morling, JR, McAllister, DA, Colhoun, HM, Farran, B, McGurnaghan, S, McCrimmon, R, Read, SH, Sattar, N, Byrne, CD & Scottish Diabetes Research Network Epidemiology Group 2018, 'Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission', Diabetes Care, vol. 41, no. 2, dc171590, pp. 341-347. https://doi.org/10.2337/dc17-1590

Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. / Wild, Sarah H (Lead / Corresponding author); Walker, Jeremy J; Morling, Joanne R; McAllister, David A; Colhoun, Helen M; Farran, Bassam; McGurnaghan, Stuart; McCrimmon, Rory; Read, Stephanie H; Sattar, Naveed; Byrne, Christopher D; Scottish Diabetes Research Network Epidemiology Group.

In: Diabetes Care, Vol. 41, No. 2, dc171590, 02.2018, p. 341-347.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission

AU - Wild, Sarah H

AU - Walker, Jeremy J

AU - Morling, Joanne R

AU - McAllister, David A

AU - Colhoun, Helen M

AU - Farran, Bassam

AU - McGurnaghan, Stuart

AU - McCrimmon, Rory

AU - Read, Stephanie H

AU - Sattar, Naveed

AU - Byrne, Christopher D

AU - Scottish Diabetes Research Network Epidemiology Group

N1 - Data linkage was funded by the Scottish Government through the Scottish Diabetes Group.

PY - 2018/2

Y1 - 2018/2

N2 - Objective: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM).Research Design and Methods: We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people ages 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and -10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors.Results: A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality.Conclusions: Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.

AB - Objective: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM).Research Design and Methods: We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people ages 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and -10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors.Results: A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality.Conclusions: Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Hepatocellular/complications

KW - Cardiovascular Diseases/epidemiology

KW - Diabetes Complications/epidemiology

KW - Diabetes Mellitus, Type 2/complications

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Liver Diseases, Alcoholic/complications

KW - Liver Neoplasms/complications

KW - Male

KW - Middle Aged

KW - Mortality

KW - Neoplasms/epidemiology

KW - Non-alcoholic Fatty Liver Disease/complications

KW - Patient Admission/statistics & numerical data

KW - Retrospective Studies

KW - Risk Factors

KW - Scotland/epidemiology

U2 - 10.2337/dc17-1590

DO - 10.2337/dc17-1590

M3 - Article

C2 - 29167212

VL - 41

SP - 341

EP - 347

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 2

M1 - dc171590

ER -