Table 2.
Joint Association of Diabetes and Psychological Distress Status with All-Cause, Cardiovascular Disease and Cancer Mortality
| Psychological Distress Status | No. of Participants | No. of Deaths | Age-Standardized Mortality Rate per 10,000 (95% CI) | Model 1 | Model 2 | p for Multiplicative Interaction† |
|---|---|---|---|---|---|---|
| HR (95% CI) | HR (95% CI) | |||||
| All-cause mortality | 0.02 | |||||
| Non-diabetes | ||||||
| No | 216,538 | 24,576 | 94.5 (94.4,94.5) | 1.00 (Reference) | 1.00 (Reference) | |
| Mild | 145,548 | 15,632 | 105.3 (105.3,105.3) | 1.11 (1.08,1.13) | 1.07 (1.04,1.09) | |
| Moderate | 69,604 | 9041 | 154.1 (154.1,154.2) | 1.61 (1.56,1.65) | 1.26 (1.22,1.30) | |
| Severe | 14,598 | 2387 | 195.8 (195.7,195.9) | 2.32 (2.19,2.46) | 1.46 (1.38,1.55) | |
| Diabetes | ||||||
| No | 16,345 | 4581 | 173.8 (173.7,173.9) | 1.59 (1.53,1.65) | 1.39 (1.33,1.44) | |
| Mild | 11,895 | 3447 | 209.3 (209.2,209.4) | 1.90 (1.83,1.98) | 1.59 (1.53,1.66) | |
| Moderate | 8575 | 2808 | 269.0 (268.8,269.2) | 2.72 (2.59,2.87) | 1.90 (1.80,2.00) | |
| Severe | 2761 | 910 | 319.7 (319.3,320.0) | 3.30 (3.02,3.61) | 1.98 (1.82,2.17) | |
| CVD mortality | 0.70 | |||||
| Non-diabetes | ||||||
| No | 216,538 | 5410 | 19.7 (19.7,19.7) | 1.00 (Reference) | 1.00 (Reference) | |
| Mild | 145,548 | 3425 | 23.2 (23.1,23.2) | 1.15 (1.09,1.21) | 1.09 (1.03,1.15) | |
| Moderate | 69,604 | 1975 | 31.3 (31.2,31.3) | 1.67 (1.57,1.79) | 1.25 (1.17,1.34) | |
| Severe | 14,598 | 485 | 41.4 (41.4,41.5) | 2.34 (2.09,2.62) | 1.39 (1.24,1.56) | |
| Diabetes | ||||||
| No | 16,345 | 1157 | 40.3 (40.2,40.3) | 1.72 (1.60,1.86) | 1.38 (1.27,1.49) | |
| Mild | 11,895 | 872 | 46.9 (46.8,46.9) | 2.11 (1.93,2.30) | 1.60 (1.46,1.75) | |
| Moderate | 8575 | 710 | 54.1 (54.1,54.2) | 3.04 (2.74,3.38) | 1.84 (1.65,2.04) | |
| Severe | 2761 | 226 | 73.4 (73.2,73.5) | 3.86 (3.25,4.58) | 1.96 (1.66,2.33) | |
| Cancer mortality | 0.94 | |||||
| Non-diabetes | ||||||
| No | 216,538 | 6339 | 25.8 (25.8,25.8) | 1.00 (Reference) | 1.00 (Reference) | |
| Mild | 145,548 | 3976 | 27.2 (27.2,27.2) | 1.07 (1.02,1.11) | 1.02 (0.98,1.07) | |
| Moderate | 69,604 | 2168 | 36.0 (35.9,36.0) | 1.39 (1.31,1.48) | 1.12 (1.05,1.19) | |
| Severe | 14,598 | 546 | 42.9 (42.9,43.0) | 1.91 (1.71,2.13) | 1.26 (1.13,1.41) | |
| Diabetes | ||||||
| No | 16,345 | 935 | 36.8 (36.8,36.9) | 1.34 (1.23,1.45) | 1.22 (1.13,1.33) | |
| Mild | 11,895 | 643 | 40.5 (40.5,40.6) | 1.41 (1.29,1.54) | 1.25 (1.13,1.37) | |
| Moderate | 8575 | 462 | 46.0 (46.0,46.1) | 1.76 (1.56,1.98) | 1.38 (1.22,1.55) | |
| Severe | 2761 | 164 | 59.6 (59.5,59.8) | 2.35 (1.93,2.86) | 1.66 (1.37,2.02) |
Notes: Model 1: adjusted for age and sex at baseline. Model 2: Model 1 plus additionally adjusted for race/ethnicity, education, income, body mass index, smoking, alcohol intake, physical activity, hypertension, CVD and cancer at baseline. †The p for multiplicative interaction between psychological distress and presence of diabetes were obtained using Wald testing.
Abbreviations: CI, confidence interval; HR, hazard ratio.