Effect-modifications by age and sex on the risks of coronary artery disease and revascularization procedures in relation to diabetes

Abstract 

Using the National Health Insurance (NHI) claim data, we assessed the effect-modifications by age and sex on the risks of coronary artery disease and revascularization procedures in relation to diabetes in Taiwan. Diabetic patients (n=500,868) and the age-and sex-matched control group (n=500,248) were linked to the inpatient claims (1997–2002) to identify hospitalizations of acute myocardial infarction, ischemic heart disease, coronary revascularization procedures. The effects of age and sex on the risks of such coronary-endpoints were evaluated by Cox proportional hazard regression model adjusted for demographics and regional area. Older ages and being males had absolutely elevated risks of all coronary-related complications, but younger and female diabetic patients had higher relative risks compared to their controls. Effect-modification by age was significant in younger patients especially in subjects <35 years for ischemic heart disease (hazard ratio [HR]=11.1; 95% confidence interval [CI]: 7.3–18.1), and coronary revascularization procedures (HR=42.9; 95% CI: 6.0–309.3). Female diabetic patients also had increased HRs of all coronary endpoints particularly for revascularization procedures. In Taiwan, very high relative hazards of coronary complications were observed in younger and female diabetic patients. We must provide an aggressive diabetic care program emphasized to those high-risk groups.

Keywords: Diabetes mellitus, Coronary disease, Epidemiology, Cohort studies, Taiwan