Trends in cause-specific mortality among people with type 2 and type 1 diabetes from 2002 to 2019: A Danish population-based study

Tinne Laurberg*, Susanne Boel Graversen, Annelli Sandbaek, Sarah H Wild, Rimke C Vos, Henrik Støvring

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Despite advances in primary and secondary prevention of cardiovascular disease,
excess mortality persists within the diabetes population. This study explores the
components of this excess mortality and their interaction with sex.
Methods
Using Danish registries (2002-2019), we identified residents aged 18-99 years, their
diabetes status, and recorded causes of death. Applying Lexis-based methods, we
computed age-standardized mortality rates (asMRs), mortality relative risks (asMRRs),
and log-linear trends for cause-specific mortality.
Findings
From 2002-2019, 958,278 individuals died in Denmark (T2D: 148,620; T1D: 7,830)
during 84.4M person-years. During the study period, overall asMRs declined, driven by
reducing cardiovascular mortality, notably in men with T2D. Conversely, cancer
mortality remained high, making cancer the leading cause of death in individuals with
T2D. Individuals with T2D faced an elevated mortality risk from nearly all cancer types,
ranging from 9% to 257% compared to their non-diabetic counterparts. Notably,
obesity-related cancers exhibited the highest relative risks: liver cancer (Men: asMRR
3·58(3·28;3·91); Women: asMRR 2·49(2·14;2·89)), pancreatic cancer (Men: asMRR
3·50(3·25;3·77); Women: asMRR 3·57(3·31;3·85)), and kidney cancer (Men: asMRR
2·10(1·84;2·40); Women: asMRR 2·31(1·92;2·79)). In men with type 2 diabetes, excess
mortality remained stable, except for dementia. In women, diabetes-related excess
mortality increased by 6-17% per decade across all causes of death, except
cardiovascular disease.
Interpretation
In the last decade, cancer has emerged as the leading cause of death among
individuals with T2D in Denmark, emphasizing the need for diabetes management
strategies incorporating cancer prevention. A sex-specific approach is crucial to
address persistently higher relative mortality in women with diabetes.
Funding
Supported by Steno Diabetes Center Aarhus, which is partially funded by an
unrestricted donation from the Novo Nordisk Foundation, and by The Danish Diabetes
Academy.
Original languageEnglish
Article number100909
Number of pages11
JournalThe Lancet Regional Health Europe
Volume41
DOIs
Publication statusPublished - 26 Apr 2024

Keywords / Materials (for Non-textual outputs)

  • Diabetes
  • Cause-specific mortality
  • Trends
  • Population-based
  • Cancer mortality

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