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

Ruiz, PLD; Chen, L; Morton, JI; Salim, Agus; Carstensen, B; Gregg, EW; Pavkov, ME; Mata-Cases, M; Mauricio, D; Nichols, GA; Pildava, S; Read, SH; Wild, SH; Shaw, Jonathan; Magliano, Dianna

doi:10.26181/19836571.v2

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

Version 2 2024-07-11, 06:02

Version 1 2022-05-24, 01:55

journal contribution

posted on 2024-07-11, 06:02 authored by PLD Ruiz, L Chen, JI Morton, Agus SalimAgus Salim, B Carstensen, EW Gregg, ME Pavkov, M Mata-Cases, D Mauricio, GA Nichols, S Pildava, SH Read, SH Wild, Jonathan ShawJonathan Shaw, Dianna MaglianoDianna Magliano

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: [Figure not available: see fulltext.]

Funding

Open Access funding enabled and organized by CAUL and its Member Institutions. The study was funded by the Centers for Disease Control and Prevention, USA and a Diabetes Australia Research Program grant. The funder of the study (the Centers for Disease Control and Prevention) was part of the study group, and contributed to study design, data interpretation and editing of the report. The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This work was partly supported by the Victoria State Government Operational Infrastructure Support Program, which did not play a role in study design/conduct, analysis/interpretation of data, or manuscript preparation. Data for Scotland were submitted on behalf of the Scottish Diabetes Research Network epidemiology group; this network is supported by NHS Research Scotland. PLDR is supported by a grant from the SouthEastern Norway Regional Health Authority. JIM is supported by an Australian Government Research Training Program Scholarship and Monash Graduate Excellence Scholarship. JES is supported by a National Health and Medical Research Council Investigator Grant.

History

Publication Date

2022-01-01

Journal

Diabetologia

Volume

65

Issue

6

Pagination

9p. (p. 964-972)

Publisher

Springer

ISSN

0012-186X

Rights Statement

© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adap- tation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.