Patterns and Trends in Mortality Associated With and Due to Diabetes Mellitus in a Transitioning Region With 3.17 Million People: Observational Study

Abstract

Background: Diabetes mellitus (DM) imposes a significant disease burden in economically transitioning regions. Most transitioning regions share similar experience in urbanization processes. Shanghai's Pudong district serves as a representative area of such regions.

Objective: We aimed to assess the burden of and trends in DM mortality in Shanghai's Pudong district and analyze the impact of aging and multimorbidity.

Methods: A longitudinal, population-based study was conducted to analyze DM mortality in Pudong from 2005 to 2020. We used joinpoint regression to analyze epidemiological features and long-term trends in crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), and years of life lost (YLL). Furthermore, the decomposition method was used to evaluate the contribution of demographic and nondemographic factors associated with mortality.

Results: There were 49,414 deaths among individuals with DM, including 15,512 deaths due to DM. The CMR and ASMRW were 109.55/10⁵ and 38.01/10⁵ person-years, respectively. Among the mortality associated with and due to DM, the total annual ASMRW increased by 3.65% (95% CI 3.25%-4.06%) and 1.38% (95% CI 0.74%-2.02%), respectively. Additionally, the total annual YLL rate increased by 4.98% (95% CI 3.92%-6.05%) and 2.68% (95% CI 1.34%-4.04%). The rates of YLL increase in persons aged 30 to 44 years (3.98%, 95% CI 0.32%-7.78%) and 45 to 59 years (4.31%, 95% CI 2.95%-5.69%) were followed by the increase in persons aged 80 years and older (10.53%, 95% CI 9.45%-11.62%) for deaths associated with DM. The annual CMR attributable to demographic factors increased by 41.9% (95% CI 17.73%-71.04%) and 36.72% (95% CI 16.69%-60.2%) for deaths associated with and due to DM, respectively. Hypertension, cerebrovascular disease, and ischemic heart disease were the top 3 comorbidities.

Conclusions: Aging and multimorbidity played essential roles in changing the burden of DM in an urbanizing and transitioning region. There is an increasing disease burden among young and middle-aged people, emphasizing the need for greater attention to these groups. Health management is an emerging method that holds important implications for alleviating the future burden of DM.

Keywords: aging; diabetes; diabetes mellitus; disease; epidemiology; mortality; multimorbidity; trend analysis; urbanization; years of life lost.

Figure 1

Flow chart of deaths selected from among all deaths in Pudong, Shanghai, from 2005 to 2020. DM: Diabetes mellitus.

Figure 2

Trends in CMR, ASMRW, age-specific proportion of mortality, and YLL among people who died of causes associated with and due to DM according to sex and age group in Pudong, Shanghai, China, from 2005 to 2020. (A) Deaths associated with DM; (B) deaths due to DM. AAPC: average annual percent change; ASMRW: age-standardized mortality rate worldwide; CMR: crude mortality rate; DM: diabetes mellitus; N/A: not applicable; YLL: years of life lost.