Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019

Abstract

Background: Diabetes has been increasing worldwide and is now among the 10 leading causes of death globally. Diabetic kidney disease (DKD), a complication of poorly managed diabetes, is related to high mortality risk. To better understand the situation in the Americas region, we evaluated diabetes and DKD mortality trends over the past 20 years.

Methods: We analysed diabetes and DKD mortality for 33 countries in the Americas from 2000 to 2019. Data were extracted from the World Health Organization (WHO) Global Health Estimates and the World Population Prospects, 2019 Revision, estimating annual age-standardized mortality rates (ASMR) and gaps in the distribution of diabetes and DKD mortality by sex and country. Trend analyses were based on the annual average percentage of change (AAPC).

Results: From 2000 to 2019, the overall mortality trend from diabetes in the Americas remained stable [AAPC: -0.2% (95% CI: -0.4%-0.0%]; however, it showed important differences by sex and by country over time. By contrast, DKD mortality increased 1.5% (1.3%-1.6%) per year, rising faster in men than women, with differences between countries. Central America, Mexico and the Latin Caribbean showed significant increases in mortality for both diseases, especially DKD. In contrast in North America, diabetes mortality decreased whereas DKD mortality increased.

Conclusions: The increase in DKD mortality is evidence of poorly controlled diabetes in the region. The lack of programmes on prevention of complications, self-care management and gaps in quality health care may explain this trend and highlight the urgent need to build more robust health systems based on primary care, prioritizing diabetes prevention and control.

Keywords: Mortality; chronic kidney disease; diabetes; diabetic kidney disease; epidemiology; trends.

Figure 1.

Average annual percent change for age-standardized mortality rate from diabetes mellitus by country and sex. Region of the Americas, 2000 to 2019. AMRO, Region of the Americas; ANR, Andean Area; BOL, Bolivia; Plurinational State of; COL, Colombia; ECU, Ecuador; PER, Peru; VEN, Venezuela, Bolivarian Republic of; CAI, Central America, Mexico and Latin Caribbean; CRI, Costa Rica; CUB, Cuba; DOM, Dominican Republic; GTM, Guatemala; HND, Honduras; HTI, Haiti; MEX, Mexico; NIC, Nicaragua; PAN, Panama; SLV, El Salvador; NLC, Non-Latin Caribbean; ATG, Antigua and Barbuda; BHS, Bahamas; BLZ, Belize; BRB, Barbados; GRD, Grenada; GUY, Guyana; JAM, Jamaica; LCA, Saint Lucia; SUR, Suriname; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; NAR, North America; CAN, Canada; USA, United States of America; SCR, Southern Cone and Brazil; ARG, Argentina; BRA, Brazil; CHL, Chile; PRY, Paraguay; URY, Uruguay.

Figure 2.

Average annual percent change for age-standardized mortality rate from diabetic kidney disease by country and sex Region of the Americas, 2000 to 2019. AMRO, Region of the Americas; ANR, Andean Area; BOL, Bolivia; Plurinational State of; COL, Colombia; ECU, Ecuador; PER, Peru; VEN, Venezuela, Bolivarian Republic of; CAI, Central America, Mexico and Latin Caribbean; CRI, Costa Rica; CUB, Cuba; DOM, Dominican Republic; GTM, Guatemala; HND, Honduras; HTI, Haiti; MEX, Mexico; NIC, Nicaragua; PAN, Panama; SLV, El Salvador; NLC, Non-Latin Caribbean; ATG, Antigua and Barbuda; BHS, Bahamas; BLZ, Belize; BRB, Barbados; GRD, Grenada; GUY, Guyana; JAM, Jamaica; LCA, Saint Lucia; SUR, Suriname; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; NAR, North America; CAN, Canada; USA, United States of America; SCR, Southern Cone and Brazil; ARG, Argentina; BRA, Brazil; CHL, Chile; PRY, Paraguay; URY, Uruguay.