The Risk of Diabetes, Dialysis, and Death among Nurses

Autor: Hsiu-ling Huang, 黃秀玲
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
Aims: Type 2 diabetes is a major chronic disease worldwide. In Taiwan, a marked increase has been observed in the female population diagnosed with diabetes, which has been the third leading cause of death for Taiwanese women. Nurses are the first-line caregivers in the medical industry and typically have shift work and irregular lifestyles. The risk of metabolic syndrome is greater among people involving working nights. This study will to use NHIRD (National Health Insurance Research Database) data for analyses. The aims of this study include: (1) The relative risk of nurses suffering from diabetes comparing to general population, (2) The relative risk of nurses with diabetes developing end-stage renal disease and requiring dialysis comparing to general patients with diabetes, (3) comparing the mortality risks of nurses with diabetes and general patients with diabetes. Methods: This retrospective longitudinal study extracted data of using National Health Insurance Registry for Beneficiaries Claims Data Files of 2000 and follow-up to December 2009. Propensity score matching was performed in a 1:1 ratio, yielding a sample of 111,670 (nurses: general population); participants in this sample were assigned to one of 2 groups that exhibited no significant difference in demographic data. Cox proportional hazards model was used to compare relative risks of diabetes and related factors between groups. Poisson distribution was used to compare relative incidence per 1,000 person years. Then the second and third section, a total population of 510 058 female patients newly diagnosed with diabetes between 1998 and 2006 as recorded in the National Health Insurance Research Database were the participants in this study. Propensity score matching was performed in a 1:10 ratio, yielding a sample of 18 601; participants in this sample were assigned to one of 2 groups that exhibited no significant difference in demographic data. The participants were tracked from the date of diagnosis to 2009. The Cox proportional hazards model was employed to compare relative risks of dialysis and mortality risks in the 2 groups and to determine the factors that resulted in differences. Results: On average, before the matching results showed that nurses were younger than general populations (31.23±8.48 years vs. 42.20±15.48 years), and more health (Average CCI: 2.93±2.89 vs. 3.48±3.43). After propensity score matching, nurses with newly diagnosed diabetes were also younger than persons with newly diagnosed diabetes in the general populations (mean age 46.98±10.80 years vs. 48.31±10.43years, p＜0.05), and had lower risk of diabetes (Adj. HR: 0.83, 95% CI: 0.78-0.89). A further analysis indicated that the factors that influenced the risk of nurses suffering from diabetes included older age and higher CCI. The results in second section showed that nurses with diabetes had lower risk of dialysis (Adj. HR: 0.36, 95%CI: 0.16-0.81). The study population with Charlson Comorbidity Index (CCI)≧5 had dialysis risk up to 5.64 times higher (95% CI: 1.79 - 17.75) than that of the reference group (CCI≦3). The overall patients with Diabetes Complications Severity Index (DCSI) ≧3 had dialysis risk up to 400.55 times higher (95% CI : 55.72 - 2879.64) than that of the reference group (DCSI=0). DCSI value was the only variable determined to be a related factor affecting dialysis risk in nurses with diabetes. Comparing the mortality risks of nurses with newly diabetes and general patient with newly diabetes showed that nurses had lower mortality risks (Adj. HR: 0.53, 95% CI : 0.38 - 0.74). Nurses with diabetes in the＜35 and 35-44 age groups exhibited significantly lower mortality risks compared with general patients with diabetes (Adj.HR: 0.23 and 0.36, p＜0.05). A further analysis indicated that the factors that influenced the mortality risks of nurses with diabetes included age, a history of cancer, other catastrophic illnesses, and the severity of diabetes complications. Conclusion: Nurses had lower risk of diabetes. Nevertheless, nurses were younger than general public suffering from newly diagnosed diabetes and had lower risk of dialysis and lower mortality risks. This suggests that the shift work of nurses may contribute to developing diabetes at a younger age than the general population, but the nurses may have better knowledge, attitudes and practice than general diabetes patients. Thus, they have a lower risk of dialysis and a lower mortality. The results of this study can serve as a reference for preventing occupational hazards, prevention in diabetes and for devising plans for improving the health of nursing professionals.
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