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Mortality trends in type 1 diabetes: a multicountry analysis of six population-based cohorts

Version 3 2024-06-19, 12:23
Version 2 2024-06-13, 17:23
Version 1 2023-02-28, 02:21
journal contribution
posted on 2024-06-19, 12:23 authored by PLD Ruiz, L Chen, JI Morton, A Salim, B Carstensen, EW Gregg, ME Pavkov, M Mata-Cases, D Mauricio, GA Nichols, S Pildava, SH Read, SH Wild, JE Shaw, DJ Magliano
Abstract Aims/hypothesis Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. Methods We assembled aggregate data on all-cause mortality during the period 2000–2016 in people with type 1 diabetes aged 0–79 years from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and the USA (Kaiser Permanente Northwest). Data were obtained from administrative sources, health insurance records and registries. All-cause mortality rates in people with type 1 diabetes, and standardised mortality ratios (SMRs) comparing type 1 diabetes with the non-diabetic population, were modelled using Poisson regression, with age and calendar time as quantitative variables, describing the effects using restricted cubic splines with six knots for age and calendar time. Mortality rates were standardised to the age distribution of the aggregate population with type 1 diabetes. Results All six data sources showed a decline in age- and sex-standardised all-cause mortality rates in people with type 1 diabetes from 2000 to 2016 (or a subset thereof), with annual changes in mortality rates ranging from −2.1% (95% CI −2.8%, −1.3%) to −5.8% (95% CI −6.5%, −5.1%). All-cause mortality was higher for male individuals and for older individuals, but the rate of decline in mortality was generally unaffected by sex or age. SMR was higher in female individuals than male individuals, and appeared to peak at ages 40–70 years. SMR declined over time in Denmark, Scotland and Spain, while remaining stable in the other three data sources. Conclusions/interpretation All-cause mortality in people with type 1 diabetes has declined in recent years in most included populations, but improvements in mortality relative to the non-diabetic population are less consistent. Graphical abstract

History

Journal

Diabetologia

Volume

65

Pagination

964-972

Location

Germany

ISSN

0012-186X

eISSN

1432-0428

Language

en

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

6

Publisher

Springer Science and Business Media LLC