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In China, regional disparities persist in prevalence of CHD, stroke in type 2 diabetes
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Significant regional differences exist in the prevalence and risks for coronary heart disease and stroke among adults with type 2 diabetes in China, according to a study published in The Journal of Clinical Endocrinology & Metabolism.
“This study aimed to investigate regional differences in the prevalence of coronary heart disease and stroke in patients with type 2 diabetes in China,” Xilin Yang, PhD, professor and director of the department of epidemiology and biostatistics at Tianjin Medical University, China, told Endocrine Today. “We also investigated whether these differences can be attributable to level hyperglycemia, high blood pressure and abnormal lipid profile.”
Yang and colleagues analyzed data from 219,522 patients with type 2 diabetes, using records from the China National HbA1c Surveillance System in 2012. Researchers used medical records from secondary or tertiary hospitals to determine prior CHD or stroke. The researchers calculated age- and sex-standardized rates of CHD and stroke and the composite of both in patients by province, provincial per capita income and geographic region. The standardization was performed using the direct method and the population distribution of China based on 2010 census data.
The researchers found that age-adjusted prevalence of CHD was 4.43% (95% CI, 4.41-4.44) in men and 4.76% (95% CI, 4.75-4.78) in women. The age-standardized prevalence of stroke was 1.74% (95% CI, 1.73-1.75) in men and 1.85 (95% CI, 1.84-1.86) in women. The standardized prevalence of either CHD or stroke was 5.67% (95% CI, 5.65-5.69) for men and 6.04% (95% CI, 6.02-6.06) in women, according to the researchers.
Notable differences were seen by province in the age- and sex-standardized prevalence of CHD, stroke and composite of both in patients with type 2 diabetes. The highest standardized rate of CHD was seen in Tianjin province (11.27%; 95% CI, 11.21-11.33). This was followed by Jilin, Shandong, Heilongjiang, Liaoning and Beijing. The highest prevalence of stroke was reported in Heilongjiang province (3.57%; 95% CI, 3.53-3.6), followed by Tianjin, Liaoning, Henan, Inner Mongolia, Beijing and Shandong, according to researchers.
When the two outcomes were analyzed in composite, Tianjin had the highest prevalence of either CHD or stroke (12.85%; 95% CI, 12.79-12.92), followed by Jilin Shandong, Heilongjiang and Beijing.
In analysis further adjusted for traditional clinical risk factors, the provinces with the highest adjusted ORs for CHD were Tianjin, Jilin, Shandong, Heilongjiang, Liaoning and Beijing (adjusted ORs ≥ 2.3). Moreover, Hunan and Shaanxi had ORs of at least 2.3 compared with Hainan. Henan and Guangxi also had among the highest adjusted ORs for stroke (aORs ≥ 2.4). When analyzed together, Jilin had the highest adjusted OR for CHD or stroke (OR = 3.74; 95% CI, 2.69-5.19).
Researchers also observed differences in age- and sex-standardized rates of CHD, stroke and the composite of both by geographic region. The highest standardized prevalence of CHD was seen in the Northeast region of the country (7.46%; 95% CI, 7.41-7.51), and this region also had the highest standardized prevalence of stroke (2.86%; 95% CI, 2.83-2.89) and the composite of both outcomes (9%; 95% CI, 8.95-9.05). Northern China had the second highest standardized CHD prevalence (7.3%; 95% CI, 7.25-7.35), as well as the highest rates of stroke (2.55%; 95% CI, 2.52-2.58) and the composite of both (8.91%; 95% CI, 8.86-8.97).
Yang said although control of high glucose, high BP and abnormal lipids played a role in these regional differences, the differences were only partially attributable to these risk factors.
“Good control of high glucose, high blood pressure and abnormal lipids are essential to reduce the rates of diabetes complications,” Yang said. “Patients with type 2 diabetes, especially in the Northeast and northern China, should make great efforts to achieve these treatment targets. Further research is warranted to investigate factors, especially lifestyle factors, which were associated with high coronary heart disease and stroke risks in the Northeast and north of China.” – by Jennifer Byrne
Disclosures: Three of the study authors report receiving research grants from Novo Nordisk China.
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