結論

The 206,685 patients with DM and 8,26,740 comparison were similar in sex and age distribution, with a mean age of 65.8 (SD, 12.0) years (Table 1). Among possible

comorbidities, hypertension, chronic kidney disease and ischemic heart disease were more prevalent in the DM cohort than in the non-DM cohort (p<0.0001). The overall incidence rate of AAA was 22% lower in the DM cohort than in the non-DM cohort (1.88 vs. 2.41per 10,000 person-years, IRR=0.78, 95% CI = 0.76–0.80), with an adjusted HR of 0.61(95% CI, 0.52–

0.72) (Table 2). Sex-specific analysis of IRR showed higher beneficial effect from DM patients in men than in women (IRR=0.71, 95% CI=0.69-0.73 vs. IRR=0.99, 95%

CI=0.96-1.02) and the adjusted HR was also higher beneficial effect in men than in women.

Age-specific analysis showed the incidence increasing with age in both cohorts. Moreover, it showed significantly highest risk to developing AAA in younger subjects (40-50 years of age) (adjusted HR= 12.4, 95%CI= 2.26–68.2). Furthermore, the beneficial effect was more

significant in those age 60 years and elderly (adjusted HR=0.66, 95%CI=0.48-0.91;adjusted HR=0.50, 95% CI=0.39-0.64; adjusted HR =0.55, 95% CI=0.39-0.79, respectively). The results of univariate and multivariate Cox proportional-hazards regression models for

association between AAA and DM or other covariates are shown in table 3. DM patients had a 19% lower risk of AAA than non-DM patients (unadjusted HR=0.81, 95% CI=0.69-0.95). The beneficial effect was stronger after adjusted for socio-demographic factors and comorbidities (adjusted HR=0.61, 95% CI=0.52-0.72).

The adjusted HR of AAA was much greater for elderly (adjusted HR=96.9, 95%

CI=48.0-195.7), compared with those in 40-50 years of age. Male gender (adjusted HR=3.75, 95% CI=3.35-4.21), hypertension (adjusted HR=1.98, 95% CI=1.75-2.24), chronic kidney disease (adjusted HR=1.91, 95% CI=1.50-2.44) and ischemic heart disease (adjusted HR=1.60, 95% CI=1.38-1.86) were associated with increased risk of developing AAA. The Kaplan-Meier survival analysis showed that patients with DM had significantly lower rates in AAA than the comparisons (Figure 1) and the curves for AAA become wider starting years- 5.

The associations between different level DM and the risks of AAAW and AAAR were shown in table 4. Compared to the non-DM cohort, the uncomplicated DM patients had a higher beneficial effect of AAAW (adjusted HR = 0.44, 95% CI = 0.32–0.61) and the advanced DM

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patients had an 33% lower risk of AAAW (adjusted HR = 0.67, 95% CI = 0.55–0.83).

However, the advanced DM patients had a higher protective role in AAAR (adjusted HR = 0.51, 95% CI = 0.30–0.89). In determination of AAAR in patients aged 60 years or more by follow-up duration, under five years after advanced DM diagnosis, the lower incidence rate of AAAR was observed. (0.63 vs. 0.91 per 10,000 person-years) and adjusted HR is 0.54 (95% CI=0.29-0.99, p<0.05).

Table.1 Demographic characteristics and comorbidity in patient with and without diabetes mellitus

40-50 101236(12.3) 25309(12.3) 0.99

50-60 166773(20.2) 41646(20.2)

Hypertension 106204(12.9) 110694(53.6) <0.0001 Chronic kidney disease 8566(1.04) 13342(6.46) <0.0001 Ischemic heart disease 45781(5.54) 38467(18.6) <0.0001 Chi-Square Test ^#: Two sample T-test

Table.2 Comparison of incidence and hazard ratio of AAA stratified by sex, and age between with and without diabetic mellitus patients

Diabetes mellitus

Compared to cohorts without DM

No Yes

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Rate^#, incidence rate, per 10,000 person-years; IRR^＊, incidence rate, ratio Adjusted HR^†: multivariable analysis including age, sex, and co-morbidity

*p<0.05, **p<0.01, ***p<0.001

Table.3 Cox model with hazard ratios and 95% confidence intervals of AAA associated with diabetes mellitus and covariates

Crude Adjusted^†

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†Adjusted HR: multivariable analysis including for age, sex, and comorbidities

*p<0.05, **p<0.01, ***p<0.001

Figure.1 Probability free of abdominal aortic aneurysm for patients with (dashed line) or without (solid line) diabetes mellitus

Table.4 Incidence, and hazard ratios of AAAW and AAAR between different level diabetes mellitus in patients aged 60 years or more

Variables Event Rate^# IRR^＊

(95% CI)

Adjusted HR^† (95% CI)

AAAW^‡

Non-DM 1096 3.03 1(Reference) 1(Reference)

Uncomplicated DM 39 1.84 0.61(0.58, 0.64)*** 0.44(0.32, 0.61)***

Advanced DM 103 2.57 0.86(0.84, 0.89)*** 0.67(0.55, 0.83)***

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AAAR^‡

Non-DM 209 0.56 1(Reference) 1(Reference)

Uncomplicated DM 12 0.57 0.98(0.94, 1.03) 0.71(0.39, 1.30) Advanced DM 15 0.37 0.66(0.63, 0.68)*** 0.51(0.30, 0.89)*

Rate^#, incidence rate, per 10,000 person-years; IRR^＊, incidence rate ratio Adjusted HR^†: multivariable analysis including age, sex, and co-morbidities

*p<0.05, **p<0.01, ***p<0.001

‡AAAW, abdominal aneurysm without mention of rupture; AAAR, abdominal aneurysm, ruptured

ICD-9-CM: uncomplicated DM, 250.0-250.3; advanced DM, 250.4- 250.9; AAAW, 441.4;

AAAR, 441.3

Table.5 Hazard ratio for AAAR compared between advanced diabetes mellitus cohort and non-diabetes mellitus cohort in patients aged 60 years or more by follow-up duration

non-DM Cohort Severe DM Cohort Compared to cohorts without DM

Follow time Event Rate^# Event Rate^# IRR^†(95% CI)

Adjusted HR^＆ (95% CI) AAAR^‡ 209 0.56 15 0.37 0.66(0.63, 0.68)*** 0.51(0.30, 0.89)*

≤5 124 0.91 12 0.63 0.68(0.66, 0.70)*** 0.54(0.29, 0.99)*

>5 85 0.66 3 0.28 0.43(0.40, 0.46)*** 0.35(0.11, 1.15) Rate^#, incidence rate, per 10,000 person-years; IRR*, incidence rate ratio; Adjusted

HR^† :multivariable analysis including age, sex, urbanization, and co-morbidities; *p<0.05,

**p<0.01, ***p<0.001

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