Age-Specific Trends From 2000–2011 in All-Cause and Cause-Specific Mortality in Type 1 and Type 2 Diabetes: A Cohort Study of More Than One Million People

Abstract

OBJECTIVETo analyze changes by age-group in all-cause and cause-specific mortality rates from 2000-2011 in people with diabetes. RESEARCH DESIGN AND METHODSA total of 1,189,079 (7.3% with type 1 diabetes) Australians with diabetes registered on the National Diabetes Service Scheme between 2000 and 2011 were linked to the National Death Index. Mortality rates in the total population were age standardized to the 2001 Australian population. Mortality rates were calculated for the following age-groups: 0 to <40 years, ‡ 40 to <60 years, and ‡60 to £85 years. Annual mortality rates were fitted using a Poisson regression model including calendar year as a covariate and age and sex where appropriate, with P trend reported. RESULTSFor type 1 diabetes, all-cause, cardiovascular disease (CVD), and diabetes agestandardized mortality rates (ASMRs) decreased each year by 0.61, 0.35, and 0.14 per 1,000 person-years (PY), respectively, between 2000 and 2011, P trend < 0.05, while cancer mortality remained unchanged. By age, significant decreases in allcause, CVD, and diabetes mortality rates were observed in all age-groups, excluding diabetes mortality in age-group 0-40 years. For type 2 diabetes, all-cause, CVD, and diabetes ASMRs decreased per year by 0.18, 0.15, and 0.03 per 1,000 PY, respectively, P trend < 0.001, while cancer remained unchanged. By age, these decreases were observed in all age-groups, excluding 0-40 years, where significant increases in all-cause and cancer mortality were noted and no change was seen for CVD and diabetes mortality. CONCLUSIONSAll-cause, CVD, and diabetes ASMRs in type 1 and type 2 diabetes decreased between 2000 and 2011, while cancer ASMRs remained unchanged. However, younger populations are not benefiting from the same improvements as older populations. In addition, the absence of a decline in cancer mortality warrants urgent attention.

Survival in Type 1 and Type 2 Diabetes in a Population Referred for Invasive Evaluation of Coronary Disease

“…Our results corroborate the general observation that diabetic patients have a higher mortality rate than the nondiabetic population under long-term observation in all subsets of coronary disease despite adjusting for baseline differences [1,2,3,4,5,6,7,8,9,10]. Most studies have only addressed survival either in type 1 or type 2 diabetes, separately, or in diabetic patients in general, and we found only 2 recent studies that actually compare survival in both type 1 and 2 diabetics with that of a nondiabetic population [23,24]. Both these studies support our observation of a higher mortality in type 1 than in type 2 diabetic patients.…”

Identifying Causes for Excess Mortality in Patients With Diabetes: Closer but Not There Yet

“…Thus, despite advances in the treatment of diabetes, there still appears to be a persistent excess risk of mortality among this population (21). Baena-Díez et al (10) showed that individuals with diabetes have an approximately threefold increased risk of cardiovascular mortality, which is much higher than what has been reported by recent studies (5,6).…”

Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997–2011

“…We considered these deaths as due to CVD, IHD or stroke, as it is not possible to die from 'uncomplicated diabetes'. The NDSS dataset linked to the NDI has previously been used to present age-specific mortality rates among those with diabetes [17].…”