Sex Differences in All-cause and Cardiovascular Mortality, Hospitalization for Individuals with and Without Diabetes, and Patients with Diabetes Diagnosed Early and Late

Objective: To compare risk of all-cause mortality, cardiovascular disease (CVD) mortality, acute myocardial infarction (AMI) mortality, stroke mortality, and hospitalizations for males and females with and without diabetes and those with diabetes diagnosed early and late.

Research Design And Methods: We conducted a population-based retrospective cohort study including 73,783 individuals aged 25 years or older in Newfoundland and Labrador, Canada (15,152 with diabetes; 9,517 with late diagnoses).

Results: Males and females with diabetes had an increased risk of all-cause mortality, CVD mortality, AMI mortality, and CVD hospitalizations compared with individuals without diabetes, and the risk was stronger in females than in males. For females, risks of all-cause mortality (hazard ratio [HR] 1.85 [95% CI 1.74-1.96]) and CVD hospitalizations (2.57 [2.24-2.94]) were significantly higher compared with their male counterparts (1.59 [1.51-1.69] and 1.92 [1.72-2.14]). Females with diabetes diagnosed late had an increased risk of CVD mortality (6.54 [4.80-8.91]) and CVD hospitalizations (5.22 [4.31-6.33]) compared with females without diabetes, and both were significantly higher compared with their male counterparts (3.44 [2.47-4.79]) and (3.33 [2.80-3.95]).

Conclusions: Females with diabetes have a greater risk of mortality than males with diabetes. CVD has a greater impact on females with diabetes than males, especially when diagnosed at a later stage. Different management strategies should be considered for males and females and those with early and late diagnoses of diabetes.