Journal Article

Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants

Huang, Jingxin, Zhu, Yikun, Wang, Lijun, Wang, Yafeng, Yu, Chuanhua, O’Neil, Adrienne, Jiao, Yurui, Lan, Yutao

2019

Overview

Background Studies have suggested sex differences in the mortality rate associated with diabetes. We conducted a meta-analysis to estimate the relative effect of diabetes on the risk of all-cause, cancer, cardiovascular disease (CVD), infectious disease, and respiratory disease mortality in women compared with men. Methods Studies published from their inception to April 1, 2018, identified through a systematic search of PubMed and EMBASE and review of references. We used the sex-specific RRs to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random-effects meta-analysis weighted by the inverse of the variances of the log RRRs. Results Forty-nine studies with 86 prospective cohorts met the inclusion criteria and were eligible for analysis. The pooled women-to-men RRR showed a 13% greater risk of all-cause mortality associated with diabetes in women than in men (RRR 1.13, 95% CI 1.07 to 1.19; P  < 0.001). The pooled multiple-adjusted RRR indicated a 30% significantly greater excess risk of CVD mortality in women with diabetes compared with men (RRR 1.30, 95% CI 1.13 to 1.49; P  < 0.001). Compared with men with diabetes, women with diabetes had a 58% greater risk of coronary heart disease (CHD) mortality, but only an 8% greater risk of stroke mortality (RRR CHD 1.58, 95% CI 1.32 to 1.90; P  < 0.001; RRR stroke 1.08, 95% CI 1.01 to 1.15; P  < 0.001). However, no sex differences were observed in pooled results of populations with or without diabetes for all-cancer (RRR 1.02, 95% CI 0.98 to 1.06; P  = 0.21), infectious (RRR 1.13, 95% CI 0.90 to 1.38; P  = 0.33), and respiratory mortality (RRR 1.08, 95% CI 0.95 to 1.23; P  = 0.26). Conclusions Compared with men with the same condition, women with diabetes have a 58% and 13% greater risk of CHD and all-cause mortality, respectively, although there was a significant heterogeneity between studies. This points to an urgent need to develop sex- and gender-specific risk assessment strategies and therapeutic interventions that target diabetes management in the context of CHD prevention.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Biomedicine / Cancer / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - epidemiology / Cardiovascular Issues in Underrepresented Populations / Communicable diseases / Complications and side effects / Coronary artery disease / Coronary heart disease / Diabetes / Diabetes mellitus / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - epidemiology / Diabetics / Disease sex factors / Evidence-based medicine / Female / Gender / Gender aspects / Gender differences / Health risk assessment / Health risks / Heart diseases / Heterogeneity / Humans / Infectious diseases / Lung diseases / Male / Medicine / Medicine & Public Health / Men / Meta-analysis / Mortality / Neoplasms - epidemiology / Patient outcomes / Prospective Studies / Research Article / Respiratory diseases / Respiratory tract diseases / Risk Assessment / Risk Factors / Sex / Sex Characteristics / Sex difference / Sex differences / Systematic review / Therapeutic applications / Type 2 diabetes / Women / Womens health