Warning: fopen(/home/virtual/enm-kes/journal/upload/ip_log/ip_log_2025-05.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 100 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 101
1Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
Copyright © 2022 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTION
Conception or design: K.D.H., J.H.K. Acquisition, analysis, or interpretation of data: Y.J.L., K.D.H. Drafting the work or revising: Y.J.L., J.H.K. Final approval of the manuscript: J.H.K.
Values are expressed as mean±standard deviation, number (%), or median (interquartile range).
NHIS, National Health Insurance Service; BMI, body mass index; HP, hypertension; DYS, dyslipidemia; CKD, chronic kidney disease; WBC, white blood cell count; SBP, systolic blood pressure; DBP, diastolic blood pressure; HLD-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; TG, triglyceride; CI, confidence interval.
Variable | Number | Event | Duration | Incidence rate, /1,000 person-years |
Hazard ratio (95% CI) |
|
---|---|---|---|---|---|---|
Non-adjusted | Adjusteda | |||||
Current cigarette smoking | ||||||
No | 1,961,924 | 5,802 | 13,512,000 | 0.42940 | 1 (Reference) | 1 (Reference) |
Yes | 682,516 | 2,976 | 4,630,204 | 0.64274 | 1.503 (1.438–1.571)b | 1.436 (1.367–1.508)b |
Heavy alcohol consumption | ||||||
No | 2,381,993 | 7,767 | 16,346,859 | 0.47514 | 1 (Reference) | 1 (Reference) |
Yes | 262,447 | 1,011 | 1,795,345 | 0.56312 | 1.187 (1.112–1.268)b | 1.082 (1.011–1.158)b |
Regular exercise | ||||||
No | 2,096,400 | 7,126 | 14,317,538 | 0.49771 | 1 (Reference) | 1 (Reference) |
Yes | 548,040 | 1,652 | 3,824,666 | 0.43193 | 0.865 (0.820–0.912)b | 0.745 (0.706–0.786)b |
Scorec | ||||||
0 | 389,891 | 1,052 | 2,734,435 | 0.38472 | 1 (Reference) | 1 (Reference) |
1 | 1,583,446 | 4,859 | 10,856,128 | 0.44758 | 1.168 (1.092–1.248)b | 1.366 (1.277–1.462)b |
2 | 555,392 | 2,347 | 3,767,964 | 0.62288 | 1.631 (1.516–1.754)b | 1.752 (1.562–1.966)b |
3 | 115,711 | 520 | 783,677 | 0.66354 | 1.739 (1.566–1.932)b | 2.448 (1.998–3.001)b |
CI, confidence interval.
a Adjusted for age, sex, smoking, alcohol consumption, exercise, limited income, hypertension, dyslipidemia, body mass index, use of insulin or oral antidiabetic drugs, and diabetic duration;
b A two-sided P value is under 0.05 indicated a statistically significant difference;
c The score was 0 in the absence of all three lifestyle habits of smoking, drinking heavily, and not regularly exercising; one point was added for each unhealthy behavior, for a total of three points for smoking, heavy drinking, and not exercising.
Variable |
Number |
Event |
Hazard ratio (95% CI) |
|||||
---|---|---|---|---|---|---|---|---|
Major | Minor | Major | Minor |
Non-adjusted |
Adjusteda |
|||
Major | Minor | Major | Minor | |||||
Current cigarette smoking | ||||||||
No | 1,961,924 | 1,961,924 | 845 | 4,957 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 682,516 | 682,516 | 495 | 2,481 | 1.717 (1.537–1.918)b | 1.467 (1.398–1.539)b | 1.683 (1.487–1.905)b | 1.394 (1.321–1.471)b |
Heavy alcohol consumption | ||||||||
No | 2,381,993 | 2,381,993 | 1,191 | 6,576 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 262,447 | 262,447 | 149 | 862 | 1.141 (0.962–1.353) | 1.196 (1.114–1.284)b | 1.012 (0.849–1.207) | 1.095 (1.018–1.179)b |
Regular exercise | ||||||||
No | 2,096,400 | 2,096,400 | 1,121 | 6,005 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 548,040 | 548,040 | 219 | 1,433 | 0.729 (0.631–0.843)b | 0.89 (0.840–0.943)b | 0.638 (0.551–0.738)b | 0.765 (0.722–0.811)b |
Scorec | ||||||||
0 | 389,891 | 389,891 | 138 | 914 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
1 | 1,583,446 | 1,583,446 | 724 | 4,135 | 1.325 (1.105–1.59)b | 1.144 (1.065–1.229)b | 1.55 (1.289–1.864)b | 1.338 (1.244–1.439)b |
2 | 555,392 | 555,392 | 393 | 1,954 | 2.08 (1.713–2.525)b | 1.563 (1.445–1.69)b | 2.428 (1.785–3.304)b | 1.655 (1.462–1.874)b |
3 | 115,711 | 115,711 | 85 | 435 | 2.165 (1.653–2.837)b | 1.675 (1.494–1.877)b | 4.287 (2.481–7.408)b | 2.226 (1.788–2.772)b |
Major, amputation above ankle; Minor, foot level amputation; CI, confidence interval.
a Adjusted for age, sex, smoking, alcohol consumption, exercise, limited income, hypertension, dyslipidemia, body mass index, use of insulin or oral antidiabetic drugs, and diabetic duration;
b A two-sided P value is under 0.05 indicated a statistically significant difference;
c The score was 0 in the absence of all three lifestyle habits of smoking, drinking heavily, and not regularly exercising; one point was added for each unhealthy behavior, for a total of three points for smoking, heavy drinking, and not exercising.
Subgroup |
Current cigarette smoking |
Heavy alcohol consumption |
Regular exercise |
|||
---|---|---|---|---|---|---|
Group | Hazard ratio (95% CI)a | Group | Hazard ratio (95% CI)a | Group | Hazard ratio (95% CI)a | |
Age, yr | ||||||
<65 | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.407 (1.323–1.496) | Yes | 1.053 (0.971–1.141) | Yes | 0.768 (0.716–0.824) | |
≥65 | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.522 (1.402–1.652) | Yes | 1.185 (1.047–1.341) | Yes | 0.702 (0.645–0.764) | |
Duration over 5 years | ||||||
No | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.722 (1.587–1.869) | Yes | 1.131 (1.020–1.255) | Yes | 0.792 (0.720–0.871) | |
Yes | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.29 (1.212–1.372) | Yes | 1.038 (0.948–1.135) | Yes | 0.719 (0.674–0.768) | |
More than three oral antidiabetic drugs | ||||||
No | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.446 (1.370–1.526) | Yes | 1.091 (1.014–1.174) | Yes | 0.747 (0.704–0.792) | |
Yes | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.384 (1.225–1.564) | Yes | 1.050 (0.880–1.254) | Yes | 0.728 (0.634–0.835) |
Variable | Total | Amputation |
P value | |
---|---|---|---|---|
No | Yes | |||
Number | 2,644,440 | 2,635,662 | 8,778 | |
Age, yr | 57.41±12.33 | 57.39±12.33 | 61.57±10.78 | <0.0001 |
20–40 | 200,993 (7.6) | 200,778 (7.62) | 215 (2.45) | <0.0001 |
40–65 | 1,647,984 (62.32) | 1,643,131 (62.34) | 4,853 (55.29) | |
≥65 | 795,463 (30.08) | 791,753 (30.04) | 3,710 (42.26) | |
Sex | <0.0001 | |||
Male | 1,587,633 (60.04) | 1,580,897 (59.98) | 6,736 (76.74) | |
Female | 1,056,807 (39.96) | 1,054,765 (40.02) | 2,042 (23.26) | |
Smoke | <0.0001 | |||
Non | 1,472,125 (55.67) | 1,467,988 (55.7) | 4,137 (47.13) | |
Ex | 489,799 (18.52) | 488,134 (18.52) | 1,665 (18.97) | |
Current | 682,516 (25.81) | 679,540 (25.78) | 2,976 (33.9) | |
Alcohol drink | <0.0001 | |||
Non | 1,514,021 (57.25) | 1,508,712 (57.24) | 5,309 (60.48) | |
Light | 867,972 (32.82) | 865,514 (32.84) | 2,458 (28) | |
Heavy | 262,447 (9.92) | 261,436 (9.92) | 1,011 (11.52) | |
Regular exercise | 548,040 (20.72) | 546,388 (20.73) | 1,652 (18.82) | <0.0001 |
Limited income (25%) | 611,073 (23.11) | 608,708 (23.1) | 2,365 (26.94) | <0.0001 |
BMI, kg/m2 | 25.07±3.4 | 25.08±3.4 | 23.96±3.33 | <0.0001 |
<18.5 | 41,569 (1.57) | 41,269 (1.57) | 300 (3.42) | <0.0001 |
<23 | 656,656 (24.83) | 653,491 (24.79) | 3,165 (36.06) | |
<25 | 656,584 (24.83) | 654,394 (24.83) | 2,190 (24.95) | |
<30 | 1,085,365 (41.04) | 1,082,630 (41.08) | 2,735 (31.16) | |
≥30 | 204,266 (7.72) | 203,878 (7.74) | 388 (4.42) | |
HP | 1,499,654 (56.71) | 1,493,541 (56.67) | 6,113 (69.64) | <0.0001 |
DYS | 1,107,349 (41.87) | 1,103,509 (41.87) | 3,840 (43.75) | 0.0004 |
CKD | 302,677 (11.45) | 300,353 (11.4) | 2,324 (26.48) | <0.0001 |
Retinopathy | 87,647 (3.31) | 86,667 (3.29) | 980 (11.16) | <0.0001 |
Nephropathy | 1,875 (0.07) | 1,738 (0.07) | 137 (1.56) | <0.0001 |
Cardio vasculopathy | 111,181 (4.2) | 110,510 (4.19) | 671 (7.64) | <0.0001 |
Cerebral vasculopathy | 45,368 (1.72) | 44,984 (1.71) | 384 (4.37) | <0.0001 |
Using insulin | 162,226 (6.13) | 160,322 (6.08) | 1,904 (21.69) | <0.0001 |
More than three oral antidiabetic drugs | 238,520 (9.02) | 237,087 (9) | 1,433 (16.32) | <0.0001 |
Diabetic duration over 5 years | 818,864 (30.97) | 813,019 (30.85) | 5,845 (66.59) | <0.0001 |
Creatinine | 0.9 (0.8–1.1) | 0.9 (0.8–1.1) | 1 (0.8–1.2) | <0.0001 |
Glucose, mg/dL | 144.65±46.86 | 144.55±46.66 | 175.76±81.9 | <0.0001 |
WBC, ×100/μL | 85.43±8.65 | 85.43±8.65 | 85.84±8.68 | <0.0001 |
SBP, mm Hg | 129.03±15.82 | 129.02±15.81 | 131.48±18.33 | <0.0001 |
DBP, mm Hg | 79.05±10.27 | 79.05±10.27 | 78.76±11.1 | 0.0094 |
Total cholesterol, mg/dL | 196.42±42.49 | 196.43±42.48 | 194.08±46.47 | <0.0001 |
HDL-C, mg/dL | 51.86±22.07 | 51.87±22.04 | 50.94±29.71 | <0.0001 |
LDL-C, mg/dL | 111.21±40.94 | 111.22±40.94 | 107.55±40.4 | <0.0001 |
TG, mg/dL (geometric mean, 95% CI) | 145.77 (145.67–145.87) | 145.74 (145.64–145.84) | 153.56 (151.7–155.44) | <0.0001 |
Variable | Number | Event | Duration | Incidence rate, /1,000 person-years | Hazard ratio (95% CI) |
|
---|---|---|---|---|---|---|
Non-adjusted | Adjusted |
|||||
Current cigarette smoking | ||||||
No | 1,961,924 | 5,802 | 13,512,000 | 0.42940 | 1 (Reference) | 1 (Reference) |
Yes | 682,516 | 2,976 | 4,630,204 | 0.64274 | 1.503 (1.438–1.571) |
1.436 (1.367–1.508) |
Heavy alcohol consumption | ||||||
No | 2,381,993 | 7,767 | 16,346,859 | 0.47514 | 1 (Reference) | 1 (Reference) |
Yes | 262,447 | 1,011 | 1,795,345 | 0.56312 | 1.187 (1.112–1.268) |
1.082 (1.011–1.158) |
Regular exercise | ||||||
No | 2,096,400 | 7,126 | 14,317,538 | 0.49771 | 1 (Reference) | 1 (Reference) |
Yes | 548,040 | 1,652 | 3,824,666 | 0.43193 | 0.865 (0.820–0.912) |
0.745 (0.706–0.786) |
Score |
||||||
0 | 389,891 | 1,052 | 2,734,435 | 0.38472 | 1 (Reference) | 1 (Reference) |
1 | 1,583,446 | 4,859 | 10,856,128 | 0.44758 | 1.168 (1.092–1.248) |
1.366 (1.277–1.462) |
2 | 555,392 | 2,347 | 3,767,964 | 0.62288 | 1.631 (1.516–1.754) |
1.752 (1.562–1.966) |
3 | 115,711 | 520 | 783,677 | 0.66354 | 1.739 (1.566–1.932) |
2.448 (1.998–3.001) |
Variable | Number |
Event |
Hazard ratio (95% CI) |
|||||
---|---|---|---|---|---|---|---|---|
Major | Minor | Major | Minor | Non-adjusted |
Adjusted |
|||
Major | Minor | Major | Minor | |||||
Current cigarette smoking | ||||||||
No | 1,961,924 | 1,961,924 | 845 | 4,957 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 682,516 | 682,516 | 495 | 2,481 | 1.717 (1.537–1.918) |
1.467 (1.398–1.539) |
1.683 (1.487–1.905) |
1.394 (1.321–1.471) |
Heavy alcohol consumption | ||||||||
No | 2,381,993 | 2,381,993 | 1,191 | 6,576 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 262,447 | 262,447 | 149 | 862 | 1.141 (0.962–1.353) | 1.196 (1.114–1.284) |
1.012 (0.849–1.207) | 1.095 (1.018–1.179) |
Regular exercise | ||||||||
No | 2,096,400 | 2,096,400 | 1,121 | 6,005 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
Yes | 548,040 | 548,040 | 219 | 1,433 | 0.729 (0.631–0.843) |
0.89 (0.840–0.943) |
0.638 (0.551–0.738) |
0.765 (0.722–0.811) |
Score |
||||||||
0 | 389,891 | 389,891 | 138 | 914 | 1 (Reference) | 1 (Reference) | 1 (Reference) | 1 (Reference) |
1 | 1,583,446 | 1,583,446 | 724 | 4,135 | 1.325 (1.105–1.59) |
1.144 (1.065–1.229) |
1.55 (1.289–1.864) |
1.338 (1.244–1.439) |
2 | 555,392 | 555,392 | 393 | 1,954 | 2.08 (1.713–2.525) |
1.563 (1.445–1.69) |
2.428 (1.785–3.304) |
1.655 (1.462–1.874) |
3 | 115,711 | 115,711 | 85 | 435 | 2.165 (1.653–2.837) |
1.675 (1.494–1.877) |
4.287 (2.481–7.408) |
2.226 (1.788–2.772) |
Subgroup | Current cigarette smoking |
Heavy alcohol consumption |
Regular exercise |
|||
---|---|---|---|---|---|---|
Group | Hazard ratio (95% CI) |
Group | Hazard ratio (95% CI) |
Group | Hazard ratio (95% CI) |
|
Age, yr | ||||||
<65 | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.407 (1.323–1.496) | Yes | 1.053 (0.971–1.141) | Yes | 0.768 (0.716–0.824) | |
≥65 | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.522 (1.402–1.652) | Yes | 1.185 (1.047–1.341) | Yes | 0.702 (0.645–0.764) | |
Duration over 5 years | ||||||
No | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.722 (1.587–1.869) | Yes | 1.131 (1.020–1.255) | Yes | 0.792 (0.720–0.871) | |
Yes | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.29 (1.212–1.372) | Yes | 1.038 (0.948–1.135) | Yes | 0.719 (0.674–0.768) | |
More than three oral antidiabetic drugs | ||||||
No | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.446 (1.370–1.526) | Yes | 1.091 (1.014–1.174) | Yes | 0.747 (0.704–0.792) | |
Yes | No | 1 (Reference) | No | 1 (Reference) | No | 1 (Reference) |
Yes | 1.384 (1.225–1.564) | Yes | 1.050 (0.880–1.254) | Yes | 0.728 (0.634–0.835) |
Values are expressed as mean±standard deviation, number (%), or median (interquartile range). NHIS, National Health Insurance Service; BMI, body mass index; HP, hypertension; DYS, dyslipidemia; CKD, chronic kidney disease; WBC, white blood cell count; SBP, systolic blood pressure; DBP, diastolic blood pressure; HLD-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; TG, triglyceride; CI, confidence interval.
CI, confidence interval. Adjusted for age, sex, smoking, alcohol consumption, exercise, limited income, hypertension, dyslipidemia, body mass index, use of insulin or oral antidiabetic drugs, and diabetic duration; A two-sided The score was 0 in the absence of all three lifestyle habits of smoking, drinking heavily, and not regularly exercising; one point was added for each unhealthy behavior, for a total of three points for smoking, heavy drinking, and not exercising.
Major, amputation above ankle; Minor, foot level amputation; CI, confidence interval. Adjusted for age, sex, smoking, alcohol consumption, exercise, limited income, hypertension, dyslipidemia, body mass index, use of insulin or oral antidiabetic drugs, and diabetic duration; A two-sided P value is under 0.05 indicated a statistically significant difference; The score was 0 in the absence of all three lifestyle habits of smoking, drinking heavily, and not regularly exercising; one point was added for each unhealthy behavior, for a total of three points for smoking, heavy drinking, and not exercising.
CI, confidence interval. Adjusted for age, sex, smoking, alcohol consumption, exercise, limited income, hypertension, dyslipidemia, body mass index, use of insulin or oral antidiabetic drugs, and diabetic duration.