{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:58:13Z","timestamp":1785567493553,"version":"3.56.0"},"reference-count":47,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":211,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82192902"],"award-info":[{"award-number":["82192902"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Individuals with both diabetes and hypertension face a heightened risk of all\u2010cause death. We aimed to validate the DHAM score\u2032s performance in predicting 5\u2010year overall mortality in two prospective cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The internal validation cohort comprised 3291 patients with diabetes and hypertension drawn from the 1999\u20132014\u2009cycles of the National Health and Nutrition Examination Survey database. The external validation cohort comprised 2478 patients from the 2008\u20132015 China Kailuan cohort. The DHAM score was constructed from eight predictors (age, sex, education, marriage, smoking, cardiovascular disease, serum albumin, and urea nitrogen). Renal dysfunction was determined by an estimated glomerular filtration rate &lt; 60\u2009mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      computed via the Chronic Kidney Disease Epidemiology Collaboration equation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The C\u2010index was 0.758 (95% CI: 0.743\u20130.833) in the NHANES database and 0.741 (95% CI: 0.731\u20130.790) in the Kailuan cohort. A DHAM score &gt; 148 independently predicted 5\u2010year all\u2010cause death in NHANES (adjusted\u2010HR 10.03, 95% CI: 3.37\u201318.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.001); after recalibration, a score &gt; 152 independently predicted mortality in Kailuan (adjusted\u2010HR 9.24, 95% CI: 4.71\u201316.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.001). The patients were further stratified by DHAM score and renal function into three risk groups. Intermediate\u2010 and high\u2010risk categories showed higher 5\u2010year all\u2010cause death rates than low\u2010risk categories across both cohorts (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The DHAM score had a robust prognostic value for 5\u2010year all\u2010cause death among individuals with both diabetes and hypertension. Higher DHAM score combined with renal dysfunction could identify patients at highest risk of all\u2010cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Chinese Registry of Clinical Trials: ChiCTR2000029767<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jdr\/8920917","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:22:13Z","timestamp":1785565333000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ability of the DHAM Score to Predict 5\u2010Year All\u2010Cause Mortality in Patients With Diabetes and Comorbid Hypertension: Validation and Risk Stratification in Two Prospective Cohorts"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9439-638X","authenticated-orcid":false,"given":"Yilu","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxuan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5814-6059","authenticated-orcid":false,"given":"Jiansong","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingyue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijie","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingdong","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhao","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7095-6022","authenticated-orcid":false,"given":"Shouling","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7352-022X","authenticated-orcid":false,"given":"Weixian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_2_16_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30431-9"},{"key":"e_1_2_16_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_2_16_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.118.314487"},{"key":"e_1_2_16_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60987-8"},{"key":"e_1_2_16_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23126500"},{"key":"e_1_2_16_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.17981"},{"key":"e_1_2_16_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1726-4901(10)70051-4"},{"key":"e_1_2_16_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcrp.2024.200265"},{"key":"e_1_2_16_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-013-2940-y"},{"key":"e_1_2_16_10_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00731"},{"key":"e_1_2_16_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad260"},{"key":"e_1_2_16_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2014.07.007"},{"key":"e_1_2_16_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-018-0662-1"},{"key":"e_1_2_16_14_2","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2013.28.1.17"},{"key":"e_1_2_16_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu18030395"},{"key":"e_1_2_16_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198111123052010"},{"key":"e_1_2_16_17_2","first-page":"1","article-title":"National Health and Nutrition Examination Survey: Analytic Guidelines 1999-2010","volume":"2","author":"Johnson C. 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