TY - JOUR
T1 - Trends in all-cause mortality among people with diagnosed diabetes in high-income settings
T2 - a multicountry analysis of aggregate data
AU - Magliano, Dianna J
AU - Chen, Lei
AU - Carstensen, Bendix
AU - Gregg, Edward W
AU - Pavkov, Meda E
AU - Salim, Agus
AU - Andes, Linda J
AU - Balicer, Ran
AU - Baviera, Marta
AU - Chan, Juliana C N
AU - Cheng, Yiling J
AU - Gardiner, Helene
AU - Gulseth, Hanne L
AU - Gurevicius, Romualdas
AU - Ha, Kyoung Hwa
AU - Jermendy, György
AU - Kim, Dae Jung
AU - Kiss, Zoltán
AU - Leventer-Roberts, Maya
AU - Lin, Chun-Yi
AU - Luk, Andrea O Y
AU - Ma, Stefan
AU - Mata-Cases, Manel
AU - Mauricio, Didac
AU - Nichols, Gregory A
AU - Pildava, Santa
AU - Porath, Avi
AU - Read, Stephanie H
AU - Robitaille, Cynthia
AU - Roncaglioni, Maria Carla
AU - Lopez-Doriga Ruiz, Paz
AU - Wang, Kang-Ling
AU - Wild, Sarah H
AU - Yekutiel, Naama
AU - Shaw, Jonathan E
N1 - Copyright © 2022 Elsevier Ltd. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND: Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes.METHODS: In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR).FINDINGS: In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources.INTERPRETATION: All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes.FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
AB - BACKGROUND: Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes.METHODS: In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR).FINDINGS: In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources.INTERPRETATION: All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes.FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
KW - Aged
KW - Diabetes Mellitus, Type 2
KW - Humans
KW - Income
KW - National Health Programs
KW - Registries
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85123371834&partnerID=8YFLogxK
U2 - 10.1016/S2213-8587(21)00327-2
DO - 10.1016/S2213-8587(21)00327-2
M3 - Journal article
C2 - 35026157
SN - 2213-8587
VL - 10
SP - 112
EP - 119
JO - The Lancet Diabetes and Endocrinology
JF - The Lancet Diabetes and Endocrinology
IS - 2
ER -