Mortality attributable to type 2 diabetes mellitus in Latin America and the Caribbean: a comparative risk assessment analysis

Abstract

Introduction: We quantified the proportion and the absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in Latin America and the Caribbean (LAC) using an estimation approach.

Research design and methods: We combined T2DM prevalence estimates from the NCD Risk Factor Collaboration, relative risks between T2DM and all-cause mortality from a meta-analysis of cohorts in LAC, and death rates from the Global Burden of Disease Study 2019. We estimated population-attributable fractions (PAFs) and computed the absolute number of attributable deaths in 1990 and 2019 by multiplying the PAFs by the total deaths in each country, year, sex, and 5-year age group.

Results: Between 1985 and 2014 in LAC, the proportion of all-cause mortality attributable to T2DM increased from 12.2% to 16.9% in men and from 14.5% to 19.3% in women. In 2019, the absolute number of deaths attributable to T2DM was 349 787 in men and 330 414 in women. The highest death rates (deaths per 100 000 people) in 2019 were in Saint Kitts and Nevis (325 in men, 229 in women), Guyana (313 in men, 272 in women), and Haiti (269 in men, 265 in women).

Conclusions: A substantial burden of all deaths is attributed to T2DM in LAC. To decrease the mortality attributable to T2DM in LAC, policies are needed to strengthen early diagnosis and management, along with the prevention of complications.

Keywords: population health; risk assessment.

Figure 1

Percentage of deaths in 1990 attributable to 1985 type 2 diabetes mellitus (T2DM) prevalence by country and sex. Exact number estimates (along with their 95% CI) are presented in online supplemental table 2.

Figure 2

Percentage of deaths in 2019 attributable to 2014 type 2 diabetes mellitus (T2DM) prevalence by country and sex. Exact number estimates (along with their 95% CI) are presented in online supplemental table 2.

Figure 3

Absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in people aged <70 years and 70+ years by sex in 1990 and 2019.

Figure 4

Age-standardized type 2 diabetes mellitus (T2DM)-attributable deaths per 100 000 people by country and year in men. Exact number estimates (along with their 95% CI) are presented in online supplemental table 2). Countries are presented in ascending order based on their death rates in 2019 (ie, countries with the highest rates in 2019 are on the right-hand side of the figure). *Countries are abbreviated according to the ISO3 code. From left to right, PER, Peru; COL, Colombia; PAN, Panama; CRI, Costa Rica; ECU, Ecuador; CUB, Cuba; CHL, Chile; BRA, Brazil; PRY, Paraguay; PRI, Puerto Rico; JAM, Jamaica; BOL, Bolivia; ATG, Antigua and Barbuda; URY, Uruguay; BMU, Bermuda; SLV, El Salvador; BRB, Barbados; BLZ, Belize; GTM, Guatemala; MEX, Mexico; DOM, Dominican Republic; ARG, Argentina; VEN, Venezuela; TTO, Trinidad and Tobago; NIC, Nicaragua; VCT, Saint Vincent and the Grenadines; DMA, Dominica; HND, Honduras; GRD, Grenada; SUR, Suriname; BHS, Bahamas; LCA, Saint Lucia; HTI, Haiti; GUY, Guyana; KNA, Saint Kitts and Nevis.

Figure 5

Age-standardized type 2 diabetes mellitus (T2DM)-attributable deaths per 100 000 people by country and year in women. Exact number estimates (along with their 95% CI) are presented in online supplemental table 2). Countries are presented in ascending order based on their death rates in 2019 (ie, countries with the highest rates in 2019 are on the right-hand side of the figure). *Countries are abbreviated according to the ISO3 code. From left to right, COL, Colombia; PER, Peru; PAN, Panama; CRI, Costa Rica; BMU, Bermuda; CHL, Chile; PRI, Puerto Rico; PRY, Paraguay; BRA, Brazil; URY, Uruguay; CUB, Cuba; ECU, Ecuador; VEN, Venezuela; ARG, Argentina; SLV, El Salvador; MEX, Mexico; NIC, Nicaragua; DOM, Dominican Republic; TTO, Trinidad and Tobago; GTM, Guatemala; LCA, Saint Lucia; JAM, Jamaica; BLZ, Belize; ATG, Antigua and Barbuda; BHS, Bahamas; BRB, Barbados; SUR, Suriname; VCT, Saint Vincent and the Grenadines; BOL, Bolivia; DMA, Dominica; GRD, Grenada; HND, Honduras; KNA, Saint Kitts and Nevis; HTI, Haiti; GUY, Guyana.