The burden of diabetes-associated multiple long-term conditions on years of life spent and lost

Abstract

Diabetes mellitus is a central driver of multiple long-term conditions (MLTCs), but population-based studies have not clearly characterized the burden across the life course. We estimated the age of onset, years of life spent and loss associated with diabetes-related MLTCs among 46 million English adults. We found that morbidity patterns extend beyond classic diabetes complications and accelerate the onset of severe MLTCs by 20 years earlier in life in women and 15 years earlier in men. By the age of 50 years, one-third of those with diabetes have at least three conditions, spend >20 years with them and die 11 years earlier than the general population. Each additional condition at the age of 50 years is associated with four fewer years of life. Hypertension, depression, cancer and coronary heart disease contribute heavily to MLTCs in older age and create the greatest community-level burden on years spent (813 to 3,908 years per 1,000 individuals) and lost (900 to 1,417 years per 1,000 individuals). However, in younger adulthood, depression, severe mental illness, learning disabilities, alcohol dependence and asthma have larger roles, and when they occur, all except alcohol dependence were associated with long periods of life spent (11-14 years) and all except asthma associated with many years of life lost (11-15 years). These findings provide a baseline for population monitoring and underscore the need to prioritize effective prevention and management approaches.

Fig. 1. Prevalence of MLTCs among women and men with and without diabetes, by age.

Among persons with diabetes, a number of conditions include diabetes. The comparative population without diabetes has at least one index condition at any time (except for diabetes).

Fig. 2. Prevalence of comorbid conditions among adults aged ≥18 years with diabetes, by sex and age group.

Men are represented by dark bars and women are represented by light bars.

Fig. 3. Median age of onset and years of life spent and lost associated with the number of conditions (including diabetes) among women and men in England.

Segment in red represents period from median age of onset of condition and death among persons who develop the noted number of conditions. Segment in blue represents the period of expected life from the equivalent age among the general population with and without comorbid conditions.

Fig. 4. Median number of expected years of life spent before death associated with the number of prevalent MLTCs, according to age, among women and men in England.

Segment in red represents years before death among persons with diabetes, according to age and number of conditions. Segment in blue represents the age-conditional life expectancy among the general same-age population with and without MLTCs.

Fig. 5. Median age of onset and years of life spent and lost associated with the combination of diabetes and additional comorbid conditions among women and men in England.

Segment in red represents period from median age of onset of condition and death among persons who develop the combination of conditions. Segment in blue represents the period from age of onset to median age of death from the equivalent age and sex among the general population with and without comorbid conditions.

Extended Data Fig. 1. Observed and expected prevalence of having both diabetes and comorbid conditions among overall adults population aged > 20 years.

Full bar represents the observed joint prevalence of diabetes with each condition; blue segment of the bar is the joint prevalence that would be expected with no etiologic association among the two conditions.