Nationwide study on trends in hospital admissions for major cardiovascular events and procedures among people with and without diabetes in England, 2004-2009

Eszter P Vamos, Christopher Millett, Camille Parsons, Paul Aylin, Azeem Majeed, Alex Bottle, Eszter P Vamos, Christopher Millett, Camille Parsons, Paul Aylin, Azeem Majeed, Alex Bottle

Abstract

Objective: It is unclear whether people with and without diabetes equally benefitted from reductions in cardiovascular disease (CVD). We aimed to compare recent trends in hospital admission rates for angina, acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) among people with and without diabetes in England.

Research design and methods: We identified all patients aged >16 years with cardiovascular events in England between 2004-2005 and 2009-2010 using national hospital activity data. Diabetes- and nondiabetes-specific rates were calculated for each year. To test for time trend, we fitted Poisson regression models.

Results: In people with diabetes, admission rates for angina, AMI, and CABG decreased significantly by 5% (rate ratio 0.95 [95% CI 0.94-0.96]), 5% (0.95 [0.93-0.97]), and 3% (0.97 [0.95-0.98]) per year, respectively. Admission rates for stroke did not significantly change (0.99 [0.98-1.004]) but increased for PCI (1.01 [1.005-1.03]) in people with diabetes. People with and without diabetes experienced similar proportional changes for all outcomes, with no significant differences in trends between these groups. However, diabetes was associated with an ~3.5- to 5-fold risk of CVD events. In-hospital mortality rates declined for AMI and stroke, remained unchanged for CABG, and increased for PCI admissions in both groups.

Conclusions: This national study suggests similar changes in admissions for CVD in people with and without diabetes. Aggressive risk reduction is needed to further reduce the high absolute and relative risk of CVD still present in people with diabetes.

Figures

Figure 1
Figure 1
Rates of admissions for CVD in people with diabetes by sex (A) and age (B) groups between 2004 and 2009 in England. Rates are expressed as 100,000 people with diabetes. Trends were tested separately for men and women and different age-groups if P < 0.05 for the sex-year or age-group–year interaction.

References

    1. Lampe FC, Morris RW, Walker M, Shaper AG, Whincup PH. Trends in rates of different forms of diagnosed coronary heart disease, 1978 to 2000: prospective, population based study of British men. BMJ 2005;330:1046.
    1. Kesteloot H, Sans S, Kromhout D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J 2006;27:107–113
    1. World Health Organization. World health statistics 2009 [article online], 2009. Available from Accessed 10 December 2011
    1. Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation 2004;109:1101–1107
    1. Booth GL, Kapral MK, Fung K, Tu JV. Recent trends in cardiovascular complications among men and women with and without diabetes. Diabetes Care 2006;29:32–37
    1. Fox CS, Coady S, Sorlie PD, et al. Trends in cardiovascular complications of diabetes. JAMA 2004;292:2495–2499
    1. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA 1999;281:1291–1297
    1. Gulliford MC, Charlton J. Is relative mortality of type 2 diabetes mellitus decreasing? Am J Epidemiol 2009;169:455–461
    1. Jansson SP, Andersson DK, Svärdsudd K. Mortality trends in subjects with and without diabetes during 33 years of follow-up. Diabetes Care 2010;33:551–556
    1. Department of Health. Health survey for England 2006 [article online], 2007. Available from Accessed 30 August 2011
    1. O’Flaherty M, Ford E, Allender S, Scarborough P, Capewell S. Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults. Heart 2008;94:178–181
    1. Department of Health. The NHS plan: a plan for investment, a plan for reform [article online], 2000. Available from Accessed 30 August 2011
    1. Department of Health. The National Service Framework for Coronary Heart Disease: winning the war on heart disease [article online], 2004. Available from Accessed 30 August 2011
    1. The NHS Information Centre. Quality and outcomes framework: audits and performance [article online], 2011. Available from Accessed 30 August 2011
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383
    1. Royal College of Paediatrics and Child Health. NHS Diabetes: growing up with diabetes: children and young people with diabetes in England [article online], 2009. Available from Accessed 30 August 2011
    1. Office for National Statistics (ONS). Publication hub: gateway to U.K. national statistics [Web site], 2011. Available from Accessed 10 December 2011
    1. Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol 2007;50:2128–2132
    1. Bottle A, Millett C, Khunti K, Majeed A. Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996-2005. Diabetologia 2009;52:74–80
    1. Vamos EP, Bottle A, Majeed A, Millett C. Trends in lower extremity amputations in people with and without diabetes in England, 1996-2005. Diabetes Res Clin Pract 2010;87:275–282
    1. Preis SR, Hwang SJ, Coady S, et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 2009;119:1728–1735
    1. National Institute for Health and Excellence (NICE). Prevention of cardiovascular disease [article online], 2010. Available from Accessed 30 August 2011
    1. Thomas RJ, Palumbo PJ, Melton LJ, 3rd, et al. Trends in the mortality burden associated with diabetes mellitus: a population-based study in Rochester, Minn, 1970-1994. Arch Intern Med 2003;163:445–451
    1. Alter DA, Khaykin Y, Austin PC, Tu JV, Hux JE. Processes and outcomes of care for diabetic acute myocardial infarction patients in Ontario: do physicians undertreat? Diabetes Care 2003;26:1427–1434
    1. Brophy JM, Diodati JG, Bogaty P, Théroux P; Quebec Acute Coronary Care Working Group The delay to thrombolysis: an analysis of hospital and patient characteristics. CMAJ 1998;158:475–480
    1. Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 1998;338:1516–1520
    1. Hamilton FL, Bottle A, Vamos EP, et al. Impact of a pay-for-performance incentive scheme on age, sex, and socioeconomic disparities in diabetes management in UK primary care. J Ambul Care Manage 2010;33:336–349
    1. Millett C, Bottle A, Ng A, et al. Pay for performance and the quality of diabetes management in individuals with and without co-morbid medical conditions. J R Soc Med 2009;102:369–377
    1. Alshamsan R, Majeed A, Vamos EP, et al. Ethnic differences in diabetes management in patients with and without comorbid medical conditions: a cross-sectional study. Diabetes Care 2011;34:655–657
    1. Hassan A, Newman A, Ko DT, et al. Increasing rates of angioplasty versus bypass surgery in Canada, 1994-2005. Am Heart J 2010;160:958–965
    1. Gerber Y, Rihal CS, Sundt TM, 3rd, et al. Coronary revascularization in the community. A population-based study, 1990 to 2004. J Am Coll Cardiol 2007;50:1223–1229
    1. Silber S, Albertsson P, Avilés FF, et al. ; Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Guidelines for percutaneous coronary interventions. Eur Heart J 2005;26:804–847
    1. Thorvaldsen P, Kuulasmaa K, Rajakangas AM, Rastenyte D, Sarti C, Wilhelmsen L. Stroke trends in the WHO MONICA project. Stroke 1997;28:500–506
    1. Rothwell PM, Coull AJ, Giles MF, et al. ; Oxford Vascular Study Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925–1933
    1. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009;8:355–369
    1. Campbell SE, Campbell MK, Grimshaw JM, Walker AE. A systematic review of discharge coding accuracy. J Public Health Med 2001;23:205–211
    1. Vamos EP, Bottle A, Edmonds ME, Valabhji J, Majeed A, Millett C. Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008. Diabetes Care 2010;33:2592–2597
    1. Audit Commission. Payment by results data assurance framework [article online], 2011. Available from Accessed 10 October 2011

Source: PubMed

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