{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T19:51:19Z","timestamp":1781725879510,"version":"3.54.5"},"reference-count":28,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009947","name":"Merck Sharp & Dohme Corp.","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009947","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To examine differences in case-fatality incidence among individuals with type 2 diabetes after major coronary or cerebrovascular events by geographic region and country income level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We studied ADVANCE, TECOS, and EXSCEL participants who experienced within-trial major coronary (fatal or nonfatal myocardial infarction or sudden cardiac death) or cerebrovascular (fatal or nonfatal stroke) events. Case fatality was defined as death at the time or within 30 days of an event. We compared geographic regions with the reference category (Western Europe, North America, or Australia and New Zealand) and compared medium- and low-income countries, based on gross national income per capita by the World Bank, with the reference category (high). Unadjusted and adjusted analyses were performed for each trial using logistic regression for individual participant data, and the results were meta-analyzed. Adjustments were made for previous cardiovascular events and risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 2,574 major coronary and 1,247 cerebrovascular events among the 40,563 study participants. Postcoronary case-fatality adjusted odds ratios (95% CIs), compared with the reference group, were 3.31 (2.32\u20134.72), 2.78 (2.11\u20133.66), and 2.84 (1.71\u20134.73) for Asia, Central and Eastern Europe, and South America and Africa, respectively. The odds ratio for low- and middle-income versus high-income countries was 3.07 (2.41\u20133.92). Case fatality after a major cerebrovascular event did not differ by geographic region or income group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Postcoronary case fatality was substantially higher in Asia, Central and Eastern Europe, and South America and Africa compared with Western countries and higher in low- and middle-income countries compared with high-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-0541","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T01:48:02Z","timestamp":1756432082000},"page":"1925-1931","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["International Variation in Case Fatality After Major Coronary or Cerebrovascular Events in Individuals With Type 2 Diabetes: Evidence From ADVANCE, TECOS, and EXSCEL"],"prefix":"10.2337","volume":"48","author":[{"given":"Philip M.","family":"Clarke","sequence":"first","affiliation":[{"name":"Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford 1 , Oxford, U.K."},{"name":"School of Population and Global Health, University of Melbourne 2 , Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyang","family":"Hua","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, University of Melbourne 2 , Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth L.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford 3 , Oxford, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chalmers","sequence":"additional","affiliation":[{"name":"George Institute for Global Health, University of New South Wales 4 , Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Woodward","sequence":"additional","affiliation":[{"name":"George Institute for Global Health, University of New South Wales 4 , Sydney, Australia"},{"name":"George Institute for Global Health, School of Public Health, Imperial College London 5 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer B.","family":"Green","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, School of Medicine, Duke University 6 , Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren K.","family":"McGuire","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital System 7 , Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee-Ling","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Malaya 8 , Kuala Lumpur, Malaysia"},{"name":"Department of Medicine and Therapeutics, Chinese University of Hong Kong 9 , Hong Kong SAR"},{"name":"Baker Heart and Diabetes Institute 10 , Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda I.","family":"Adler","sequence":"additional","affiliation":[{"name":"Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford 3 , Oxford, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1256-874X","authenticated-orcid":false,"given":"Rury R.","family":"Holman","sequence":"additional","affiliation":[{"name":"Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford 3 , Oxford, 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