Aims: Few researchers have studied whether diabetes itself is responsible for high rates of disability or mortality, or if factors associated with diabetes contribute importantly. We estimated associations of diabetes, heart disease, obesity, and physical inactivity with life expectancy (LE), the proportion of life with disability (DLE), and disability in the last year of life.
Methods: Data were from the Panel Study of Income Dynamics (1999-2011 and 1986, African American and white women and men ages 55+, n=1,980, 17,352 person-years). Activities of daily living defined disability. Multinomial logistic Markov models estimated disability transition probabilities adjusted for age, sex, race/ethnicity, education, and the health factors. Microsimulation measured outcomes.
Results: White women and men exemplify results. LE was, for women: 3.5 years less with diabetes than without (95% confidence interval, 3.1-4.0), 11.1 less (10.3-12.0) adding heart disease, 21.9 less with all factors (15.3-28.5), all p<0.001. Corresponding results for men: 1.7 years (0.9-2.3, not significant), 8.2 (6.8-9.5) and 18.1 (15.6-20.6), both p<0.001. DLE was, for women: 23.5% (21.7-25.4) with no risk factors, 27.1% (25.7-28.6) with diabetes alone, 34.6% (33.1-36.1) adding heart disease, 52.9% (38.9-66.8) with all factors, all p<0.001; for men: 13.2% (11.7-14.6), 16.3% (14.8-17.8, p<0.01); and 22.1% (20.5-23.7), 36.4% (25.0-47.8), both p<.001. Among people with diabetes, those with other conditions were much less likely to have no disability in the final year of life.
Conclusions: Much of the disability and mortality with diabetes was due to heart disease, obesity, and inactivity, risks that can be modified by health behaviors and medical care.
Keywords: African Americans; Aging; Diabetes; Disability; Mortality; Physical activity.
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