Objective: Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women versus men.
Methods: We systematically searched PubMed, Embase, and Web of Science for studies published from their starting dates to 7 Aug 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs. men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse-variance weighted random-eﬀects meta-analysis. Subgroup analyses were used to explore potential sources of heterogeneity.
Results: The 35 analyzed prospective cohort studies included 2,314,292 individuals, among whom 254,038 all-cause deaths occurred. The pooled women vs. men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI 1.12-1.23, I2=81.6%) and 1.97 (95% CI 1.49-2.61, I2=86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up longer than 10 years, and 1.10 in articles in which the duration of follow-up less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI 2.02-2.69) in women and 1.91 (95% CI 1.72-2.12) in men, compared with their healthy counterparts.
Conclusions: The effect of diabetes on all-cause and CHD mortality is approximately 17% and 97% greater, respectively, for women than for men.