Introduction: Previous studies have shown sex differences in the all cause mortality rate associated with type 2 diabetes.
Hypothesis: We did a meta-analysis to provide reliable and comprehensive estimates of type 2 diabetes on risk of all-cause mortality in women versus men.
Methods: We systematically searched PubMed, Embase, and Web of science for studies published from their starting dates to October 10, 2017. Studies were selected only if they reported sex-specific estimates of the standardized mortality ratio (SMR) or hazard ratios associated with type 2 diabetes for all-cause mortality. We used random effects meta-analyses with inverse-variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality. Study quality was assessed using the Newcastle–Ottawa scale.
Results: Data from 30 studies including 2,307,694 individuals and 252,491 deaths occurred were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·14 (95% CI 1.09-1.19, p<0.001; I2=81.6%). Compared with healthy counterparts, the pooled SMR for all-cause mortality in patients with T2D was 2.30(95%CI 1.97-2.68) in women, and 1.94(95%CI 1.73-2.18) in men, respectively. Sensitivity analysis with omission of one study at a time did not change the results of this meta-analysis.
Conclusions: Women with type 2 diabetes have a roughly 14% greater excess risk of all-cause mortality compared with men counterparts. This meta-analysis was registered at the International Prospective Register of Systematic Reviews (Prospero) (http://www.crd.york.ac.uk/PROSPERO; registration number: CRD42017074187).
Figure 1.Pooled women-to-men ratios of SMRs for all-cause mortality, comparing people with type 2 diabetes versus healthy counterparts.