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. 2023 May;11(3):e003378.
doi: 10.1136/bmjdrc-2023-003378.

Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada

Laura C Rosella  1   2   3   4 , Kathy Kornas  5 , Ednah Negatu  5 , Limei Zhou  2
Affiliations

Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada

Laura C Rosella et al. BMJ Open Diabetes Res Care. 2023 May.

Abstract

Introduction: Patients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in the population are lacking. This study aimed to examine the sociodemographic differences in the risk of all-cause mortality, premature mortality, and cause-specific mortality in persons diagnosed with diabetes.

Research design and methods: We conducted a population-based cohort study of 1 741 098 adults diagnosed with diabetes between 1994 and 2017 in Ontario, Canada using linked population files, Canadian census, health administrative and death registry databases. We analyzed the association between sociodemographics and other covariates on all-cause mortality and premature mortality using Cox proportional hazards models. A competing risk analysis using Fine-Gray subdistribution hazards models was used to analyze cardiovascular and circular mortality, cancer mortality, respiratory mortality, and mortality from external causes of injury and poisoning.

Results: After full adjustment, individuals with diabetes who lived in the lowest income neighborhoods had a 26% (HR 1.26, 95% CI 1.25 to 1.27) increased hazard of all-cause mortality and 44% (HR 1.44, 95% CI 1.42 to 1.46) increased risk of premature mortality, compared with individuals with diabetes living in the highest income neighborhoods. In fully adjusted models, immigrants with diabetes had reduced risk of all-cause mortality (HR 0.46, 95% CI 0.46 to 0.47) and premature mortality (HR 0.40, 95% CI 0.40 to 0.41), compared with long-term residents with diabetes. Similar HRs associated with income and immigrant status were observed for cause-specific mortality, except for cancer mortality, where we observed attenuation in the income gradient among persons with diabetes.

Conclusions: The observed mortality variations suggest a need to address inequality gaps in diabetes care for persons with diabetes living in the lowest income areas.

Keywords: immigrant status; income; mortality; socioeconomic status; type 2.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Presence of chronic conditions at time of diabetes diagnosis by sex, 1994–2017. COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Healthcare costs in the last 2 years of life for those who died with diabetes from 2004 to 2007. A) Total health care costs; B) Average per person health care costs
See this image and copyright information in PMC

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