Trends in all-cause mortality among people with diagnosed diabetes: a multi-country analysis of aggregate data from 21 million deaths in diabetes in high-income settings

Dianna J Magliano*, Lei Chen, Bendix Carstensen, Edward W Gregg, Meda E Pavkov, Agus Salim , Linda J Andes , Ran Balicer, Marta Baviera, Juliana C. N. Chan, Yiling J Cheng , Helene Gardiner, Hanne L Gulseth , Romualdas Gurevicius , Kyoung Hwa Ha, György Jermendy, Dae Jung Kim, Zoltán Kiss, Maya Leventer-Roberts , Chun-Yi LinAndrea O Y Luk, Stefan Ma, Manel Mata-Cases, Didac Mauricio, Gregory A Nichols, Santa Pildava , Avi Porath , Stephanie Read, Cynthia Robitaille , Maria Carla Roncaglioni, Paz Lopez-Doriga Ruiz, Kang-Ling Wang, Sarah H Wild, Naama Yekutiel, Jonathan E Shaw

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background Population-level trends in mortality among people with diabetes are inadequately described. Using a multicountry analysis, we aimed to examine the magnitude and trends in excess mortality related to diabetes.
Methods We collected data from 1995-2016 on all-cause mortality in people with diagnosed diabetes from 19 data sources in 16 jurisdictions. Data were from administrative sources, health insurance records, registries and a health-survey. Excess mortality was estimated as the standardised mortality ratio (SMR).
Findings There were 21 million deaths during 0.5 billion person-years among people with diagnosed diabetes. Seventeen of nineteen data sources showed declines in the age- and sex-standardised mortality rates in people with diabetes, with an annual percentage change in mortality ranging from -4.2% to -0.5%. The largest declines in mortality were observed in East and South East Asia (Hong Kong, South Korea, Taiwan, Singapore). Mortality decreased over time at all ages in most countries, with a suggestion in some countries that the rate of decrease may have been greater at younger ages. Among the 17 data sources with declining mortality among persons with diabetes, we found a significant SMR increase in 5, no significant SMR change in 4, and a significant SMR decrease in 8 jurisdictions.
Interpretation and funding All-cause mortality in diabetes has declined in most of the high-income countries we assessed. In nearly 50% of the datasets 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: This work was funded by the US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
Original languageEnglish
Pages (from-to)112-119
JournalThe Lancet Diabetes & Endocrinology
Volume10
Issue number2
Early online date10 Jan 2022
DOIs
Publication statusPublished - 1 Feb 2022

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