Introduction: Chronic constipation (CC) is common among women with type 2 diabetes (T2D), likely due to microvascular, neuropathic, and microbiome changes. It is unknown whether CC confers additional mortality risk. We determined the association between CC and risk of all-cause mortality in U.S. adult women with & without T2D.
Methods: We included non-pregnant women ≥20 years from the National Health and Nutrition Examination Survey 2005-2010 linked to the National Death Index through 2019. We excluded women taking insulin, with inflammatory bowel disease, prior bowel surgeries, or chronic diarrhea. T2D was defined as HbA1c ≥6.5%, fasting blood glucose ≥126 mg/dl, or self-reported diagnosis. CC was defined as bowel frequency <4 BMs/week and bowel consistency using Bristol Stool Form Scale (BSFS) Type 1-2. The reference was women with >3 BMs/week & BSFS Type 3-5. We used survey design-adjusted Cox regression with covariates determined a priori (demographics, smoking, exercise, diet, waist size, BP, HbA1c, T2D medication use, laxative use).
Results: Among 5,620 women (mean age 47y, 72% non-Hispanic White [NHW], 8.3% T2D), 154 (2.6%) had CC. Across a mean 11.4y (SD, 2.7y) of follow-up, 678 (10%) died. Women with CC were more likely to have lower income & education, poor self-reported health, and other T2D complications. Among women with T2D, CC had 2 times the risk of mortality (HR [95% CI]; unadjusted: 3.27 [1.62, 6.58], adjusted: 2.06 [1.11, 3.85]). Income & education most significantly attenuated risk estimates (34% change). There was no association between CC and mortality in women without T2D (unadjusted: 0.94 [0.51, 1.71], adjusted: 1.04 [0.62, 1.74]).
Conclusion: CC was present in nearly 3% of women. Only in women with T2D was CC associated with more than twice the risk of mortality, suggesting CC may be a symptom of T2D complication. Further longitudinal studies are needed to examine temporality of CC onset with other complications.
A. Visaria: None. N. Shah: None.
