The Effect of Cardiovascular Multimorbidity on Type 2 Diabetes Mortality: A Secondary Data Analysis Using Big Data from Academic Health System Universitas Gadjah Mada

Geraldinha Meliala, dr. Hasanah Mumpuni, Sp.PD, Sp.JP(K); dr. Ahmad Watsiq Maula, MPH

2026 | Skripsi | PENDIDIKAN DOKTER

Pendahuluan: Diabetes melitus tipe 2 merupakan masalah kesehatan global yang berhubungan dengan peningkatan morbiditas dan mortalitas. Penyakit kardiovaskular merupakan salah satu penyebab utama kematian pada pasien dengan diabetes melitus tipe 2. Keberadaan dua atau lebih penyakit kardiovaskular, yang dikenal sebagai multimorbiditas kardiovaskular, dapat meningkatkan risiko kematian akibat meningkatnya beban penyakit. Namun, data mengenai dampak multimorbiditas kardiovaskular terhadap mortalitas pada pasien diabetes melitus tipe 2 di Indonesia masih terbatas.

Tujuan: Penelitian ini bertujuan untuk mengevaluasi pengaruh multimorbiditas kardiovaskular terhadap mortalitas pada pasien diabetes melitus tipe 2 serta mengidentifikasi komorbiditas kardiovaskular yang berkontribusi terhadap mortalitas.

Metode: Penelitian ini menggunakan rancangan kohort retrospektif dengan menganalisis data kunjungan rumah sakit dari Big Data Academic Health System Universitas Gadjah Mada. Subjek penelitian adalah pasien dewasa (?18 tahun) dengan diabetes melitus tipe 2 yang menjalani perawatan di RSUP Dr. Sardjito dan RSA UGM pada periode 2017-2019 dan diikuti selama 2 tahun. Multimorbiditas kardiovaskular didefinisikan sebagai keberadaan dua atau lebih penyakit kardiovaskular. Analisis deskriptif, bivariat, dan regresi logistik multivariat dilakukan untuk menilai hubungan antara multimorbiditas kardiovaskular dan mortalitas.

Hasil: Dari 13.267 pasien, multimorbiditas kardiovaskular ditemukan pada 548 pasien (4,1%). Angka kematian lebih tinggi pada pasien dengan multimorbiditas kardiovaskular dibandingkan dengan pasien tanpa multimorbiditas. Multimorbiditas kardiovaskular ditemukan memiliki hubungan dengan peningkatan angka kematian (OR 2,33; 95% CI 1,82 – 2,97) setelah penyesuaian terhadap usia, jenis kelamin, dan status sosial ekonomi. Infark miokard akut, stroke, dan fibrilasi atrium merupakan prediktor mortalitas terkuat.

Kesimpulan: Multimorbiditas kardiovaskular meningkatkan angka kematian pada pasien dengan diabetes melitus tipe 2.

Kata kunci: diabetes melitus tipe 2, multimorbiditas kardiovaskular, mortalitas, penyakit kardiovaskular, Academic Health System

Background: Type 2 diabetes mellitus (T2DM) is a major global public health problem and is associated with increased morbidity and mortality. Cardiovascular disease is the leading cause of death among patients with T2DM. The coexistence of two or more cardiovascular diseases, known as cardiovascular multimorbidity, may further increase the risk of mortality due to greater disease burden. However, evidence regarding the impact of cardiovascular multimorbidity on mortality among patients with T2DM in Indonesia remains limited.

Objective: This study aimed to evaluate the effect of cardiovascular multimorbidity on mortality among patients with type 2 diabetes mellitus and to identify the most common cardiovascular comorbidities contributing to mortality.

Method: This retrospective cohort study analyzed hospital visit data obtained from the Big Data AHS Universitas Gadjah Mada. Adult patients (?18 years) with T2DM who were admitted to RSUP Dr. Sardjito and RSA UGM between 2017 and 2019 were included and followed for two years. Cardiovascular multimorbidity was defined as the presence of two or more cardiovascular comorbidities. Descriptive analysis, bivariate analysis, and multivariable logistic regression were used to assess the association between cardiovascular multimorbidity and mortality.

Results: A total of 13,267 patients were included, and cardiovascular multimorbidity was present in 548 patients (4.1%). Mortality was higher among patients with cardiovascular multimorbidity compared with those without. Cardiovascular multimorbidity was significantly associated with mortality (OR 2.33; 95% CI 1.82– 2.97) after adjustment for age, sex, and socioeconomic status. Acute myocardial infarction, stroke, and atrial fibrillation were the strongest predictors of mortality.

Conclusion: Cardiovascular multimorbidity is associated with increased mortality among patients with type 2 diabetes mellitus.

Keywords: type 2 diabetes mellitus; cardiovascular multimorbidity; mortality; cardiovascular disease; Academic Health System

Kata Kunci : type 2 diabetes mellitus; cardiovascular multimorbidity; mortality; cardiovascular disease; Academic Health System