Julian W Sacre1, Jessica L Harding2, Jonathan E Shaw1, Dianna J Magliano3,4. 1. Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia. 2. Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA. 3. Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia. 4. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
BACKGROUND: Excess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends. METHODS: All-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general population] were examined in 1 268 018 Australians with T2DM registered on the National Diabetes Services Scheme (2002-2014). RESULTS: Age-standardized mortality decreased in men (-2.2%/year; Ptrend < 0.001) and women with T2DM (-1.3%/year; Ptrend < 0.001) throughout 2002-14, which translated to declines in the MRRs (from 1.51 to 1.45 in men; 1.59 to 1.46 in women; Ptrend < 0.05 for both). Declining mortality rates in T2DM were observed in men aged 40+ years and women aged 60+ years (Ptrends <0.001), but not at younger ages. However, the only age group in which excess mortality declined relative to those without diabetes was 80+ years (Ptrends < 0.05); driven by reductions in excess cancer-related deaths in men and cardiovascular disease (CVD) in women. Among age groups <80 years, CVD and cancer MRRs remained similar or increased over time, despite falls in both CVD and cancer mortality rates. MRRs for non-CVD/non-cancer-related deaths increased in 60-79 year-olds, but were otherwise unchanged. CONCLUSIONS: Declining excess mortality attributable to T2DM from 2002-14 was driven entirely by reductions in those aged 80+ years. Declines in total mortality among those with T2DM were apparent in more age groups, but often to a lesser extent than in the general population, thereby serving to increase the excess risk associated with T2DM.
BACKGROUND: Excess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends. METHODS: All-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general population] were examined in 1 268 018 Australians with T2DM registered on the National Diabetes Services Scheme (2002-2014). RESULTS: Age-standardized mortality decreased in men (-2.2%/year; Ptrend < 0.001) and women with T2DM (-1.3%/year; Ptrend < 0.001) throughout 2002-14, which translated to declines in the MRRs (from 1.51 to 1.45 in men; 1.59 to 1.46 in women; Ptrend < 0.05 for both). Declining mortality rates in T2DM were observed in men aged 40+ years and women aged 60+ years (Ptrends <0.001), but not at younger ages. However, the only age group in which excess mortality declined relative to those without diabetes was 80+ years (Ptrends < 0.05); driven by reductions in excess cancer-related deaths in men and cardiovascular disease (CVD) in women. Among age groups <80 years, CVD and cancer MRRs remained similar or increased over time, despite falls in both CVD and cancer mortality rates. MRRs for non-CVD/non-cancer-related deaths increased in 60-79 year-olds, but were otherwise unchanged. CONCLUSIONS: Declining excess mortality attributable to T2DM from 2002-14 was driven entirely by reductions in those aged 80+ years. Declines in total mortality among those with T2DM were apparent in more age groups, but often to a lesser extent than in the general population, thereby serving to increase the excess risk associated with T2DM.
Authors: Thaddäus Tönnies; Jens Baumert; Christin Heidemann; Elena von der Lippe; Ralph Brinks; Annika Hoyer Journal: Popul Health Metr Date: 2021-10-11
Authors: Jessica L Harding; Stephen R Benoit; Israel Hora; Lakshmi Sridharan; Mohammed K Ali; Ram Jagannathan; Rachel E Patzer; K M Venkat Narayan Journal: BMJ Open Diabetes Res Care Date: 2021-10
Authors: Paz L D Ruiz; Lei Chen; Jedidiah I Morton; Agus Salim; Bendix Carstensen; Edward W Gregg; Meda E Pavkov; Manel Mata-Cases; Didac Mauricio; Gregory A Nichols; Santa Pildava; Stephanie H Read; Sarah H Wild; Jonathan E Shaw; Dianna J Magliano Journal: Diabetologia Date: 2022-03-22 Impact factor: 10.122