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. 2021 Nov;9(2):e002529.
doi: 10.1136/bmjdrc-2021-002529.

Secular incidence trends and effect of population aging on mortality due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Yongze Li  1 , Chenxi Guo  2 , Yanli Cao  3
Affiliations

Secular incidence trends and effect of population aging on mortality due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Yongze Li et al. BMJ Open Diabetes Res Care. 2021 Nov.

Abstract

Introduction: Diabetes and population aging have become public health issues of global concern. The secular incidence trends and the impact of population aging on mortality due to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in China remain unclear.

Research design and methods: The incidence and mortality rates of T1DM and T2DM from 1990 to 2019 were abstracted from the Global Burden of Disease Study (GBD) 2019 database. Joinpoint regression and age-period-cohort models were used to calculate the average annual percentage change and relative risk (RR), respectively. A decomposition method was used to attribute changes in total deaths to population growth, population aging, and the mortality rate change from 1990 to 2019.

Results: From 1990 to 2019, the T1DM age-standardized incidence rate (ASIR) increased by 2.01% (95% CI 1.78% to 2.23%) in males and 1.70% (1.61% to 1.80%) in females, and the T1DM age-standardized mortality rate (ASMR) decreased by 1.96% (-2.22% to -1.71%) in males and 4.02% (-4.48% to -3.57%) in females. The T2DM ASIR increased by 0.81% (0.62% to 0.99%) in males and 0.37% (0.16% to 0.58%) in females, and the T2DM ASMR increased by 1.06% (0.87% to 1.25%) in males and decreased by 0.24% (-0.54% to 0.07%) in females. Compared with 1990, the proportions of deaths attributed to population aging ranged from 18.85% (T1DM) to 148.21% (T2DM) for males and 29.80% (T1DM) to 118.82% (T2DM) for females in 2019.

Conclusions: The T1DM and T2DM incidence rates continually increased in China, particularly among young individuals. T1DM-related mortality decreased, while T2DM-related mortality increased in males. Population aging might be associated with a substantial change in the number of deaths from 1990 to 2019. To address the increase in T2DM-related deaths due to population aging, policymakers should promote aging-related health research and implement proven, cost-effective T2DM interventions.

Keywords: aging; epidemiology; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trends in the age-standardized incidence and mortality rates of T1DM (A) and T2DM (B) by sex from 1990 to 2019.
Figure 2
Figure 2
Relative risks of T1DM and T2DM incidence in China from 1990 to 2019 due to age, period, and cohort effects.
Figure 3
Figure 3
Changes in the number of T1DM-related and T2DM-related deaths associated with population aging, population growth, and changes in mortality rates from 1990 to 2019. Note: The decomposition was conducted using the number of deaths in 1990 as the reference for each year.
Figure 4
Figure 4
Proportions of T1DM and T2DM deaths associated with population aging by sex, 1990–2019. Note: The decomposition analysis was conducted using the number of deaths in 1990 as the reference. The attributed proportion of deaths was calculated as the number of deaths attributed to population aging divided by total deaths in 1990×100%.
See this image and copyright information in PMC

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