Global trend of diabetes mortality attributed to vascular complications, 2000-2016

Abstract

Background: The global epidemic of diabetes mellitus continues to grow and affects developed and developing countries alike. Intensive glycemic control is thought to modify the risks for vascular complications, hence the risks for diabetes-related death. We investigated the trend of diabetic vascular complication-related deaths between 2000 and 2016 in the global diabetes landscape.

Methods: We collected 17 years of death certificates data from 108 countries in the World Health Organization mortality database between 2000 and 2016, with coding for diabetic complications. Crude and age-standardized proportions and rates were calculated. Trend analysis was done with annual average percentage change (AAPC) of rates computed by joinpoint regression.

Results: From 2000 through 2016, 7,108,145 deaths of diabetes were reported in the 108 countries. Among them, 26.8% (1,904,787 cases) were attributed to vascular complications in damaged organs, including the kidneys (1,355,085 cases, 71.1%), peripheral circulatory (515,293 cases, 27.1%), nerves (28,697 cases, 1.5%) and eyes (5751 cases, 0.3%). Overall, the age-standardized proportion of vascular complication-related mortality was 267.8 [95% confidence interval (95% CI), 267.5-268.1] cases per 1000 deaths and the rate was 53.6 (95% CI 53.5-53.7) cases per 100,000 person-years. Throughout the 17-year period, the overall age-standardized proportions of deaths attributable to vascular complications had increased 37.9%, while the overall age-standardized mortality rates related to vascular complications had increased 30.8% (AAPC = 1.9% [1.4-2.4%, p < 0.05]). These increases were predominantly driven by a 159.8% increase in the rate (AAPC = 2.7% [1.2-4.3%, p < 0.05]) from renal complications. Trends in the rates and AAPC of deaths varied by type of diabetes and of complications, as well as by countries, regions and domestic income.

Conclusion: Diabetic vascular complication-related deaths had increased substantially during 2000-2016, mainly driven by the increased mortality of renal complications.

Keywords: Diabetes mellitus; Diabetic nephropathy; Mortality; Vascular complication.

Fig. 1

Crude and age-standardized proportions and rates, by country; Data were sorted by the number of age-standardized proportions and rates; dash line denotes 100 cases per 1000 deaths in proportions and 100 cases per 100 000 person years in rates. The number below the X axis was country codes (corresponding country name was shown in Additional file 1: Appendix S17)

Fig. 2

Odds ratios (ORs) of crude and age-standardized proportions and rates compared to year 2000, by sex; Data presented as estimate ± 95% CI; Circles, crude estimates; Squares, age-standardized estimates; a, c, e represent proportions; b, d, f represent rates; a, b were ORs in overall estimates; c, d were ORs in male estimates; e, f were ORs in female estimates

Fig. 3

Trend of age-standardized mortality rates (per 100 000 person years) in overall and subgroups by sex, diabetes types and complication types; red squares denote the observed values and line denotes the slope of the APC in different segments; A for overall, B and C for subgroups by sex (B: male, C: female); D-H for subgroups by diabetes types (D: T1DM; E: T2DM; F: other specified DM; G: malnutrition-related DM; H: unspecified DM); I-L for subgroups by complication types (I: renal complication; J: peripheral circulatory complication; K: neurological complication; L: ophthalmic complication); APC = annual percentage change; * denotes a p value less than 0.05

Fig. 4

Trend of age-standardized mortality rates (per 100 000 person years) in subgroups by regions; red squares denote the observed values and line denotes the slope of the APC in different segments; A for Africa, B for Asia; C for Caribbean; D for Europe; E for Middle East; F for North America; G for Oceania; H for South America; D-H for subgroups by diabetes types (D: T1DM; E: T2DM; F: other specified DM; APC = annual percentage change; * denotes a p value less than 0.05