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. 2022 Jun;65(6):964-972.
doi: 10.1007/s00125-022-05659-9. Epub 2022 Mar 22.

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

Paz L D Ruiz  1   2   3 , Lei Chen  3 , Jedidiah I Morton  3   4 , Agus Salim  3   5 , Bendix Carstensen  6 , Edward W Gregg  7 , Meda E Pavkov  8 , Manel Mata-Cases  9   10 , Didac Mauricio  9   10   11 , Gregory A Nichols  12 , Santa Pildava  13 , Stephanie H Read  14 , Sarah H Wild  14 , Jonathan E Shaw  3   4   15 , Dianna J Magliano  16   17
Affiliations

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

Paz L D Ruiz et al. Diabetologia. 2022 Jun.

Abstract

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.

Keywords: Consortium; Mortality; Non-communicable disease; Population health; Trends; Type 1 diabetes.

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Figures

Fig. 1
Fig. 1
Age- and sex-standardised all-cause mortality rates in people with type 1 diabetes by calendar year. Standardisation is based on annual age-specific mortality rates from age–period–cohort models fitted separately for each data source and sex. The standard population was derived from the pooled study population with type 1 diabetes within the six data sources, with equal weights for male and female individuals. Shaded areas represent 95% CIs around mortality trends. The y-axis is plotted on a natural logarithmic scale. aData are from Catalonia, Spain
Fig. 2
Fig. 2
Annual estimated change in all-cause mortality rates in type 1 diabetes (a, c) and annual estimated change in SMR in type 1 diabetes relative to those without diabetes (b, d), in all individuals (a, b) and in male and female individuals separately (c, d). Data in (a, b) are ordered according to the magnitude of annual change in all-cause mortality rates in people with type 1 diabetes. Blue lines, male; red lines, female. Error bars indicate 95% CIs. aData are from Catalonia, Spain. SMR, standardised mortality ratio
Fig. 3
Fig. 3
SMR in people with type 1 diabetes compared with those without diabetes by calendar year. Smoothing is based on a model with SMR constant over age and sex. Shaded areas represent 95% CIs. The y-axis is plotted on a natural logarithmic scale. aData are from Catalonia, Spain. SMR, standardised mortality ratio
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