Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study

Abstract

Aims/hypothesis The aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016. Methods The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes. Results Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45-74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20-44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change [AAPC]: −3.2% [95% CI −7.3%, 1.0%]) and women (AAPC: −1.2% [95% CI −6.5%, 4.4%]). The SMRs in people aged 20−44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016. Conclusions/interpretation Absolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.

Diabetes and COVID‐19

“…Mortality rates among persons with diabetes in Hong Kong age 75 and over from pneumonia currently exceed mortality rates in this age group from cardiovascular disease and from cancer. 8 Similar evidence of risk among persons with diabetes has been reported for the two earlier CoV infections, severe acute respiratory syndrome (SARS) beginning in 2002 and affecting more than 8000 persons, mainly in Asia 9,10 and the Middle East respiratory syndrome (MERS) in 2012 affecting more than 2000 persons, mainly in Saudi Arabia. 11 As MERS-CoV binds to the receptor-binding domain of human dipeptidyl peptidase IV (DPP-IV), a transgenic mouse model expressing this DPP-IV receptor on pulmonary alveolar cells has been used to study the effect of diabetes in worsening disease severity, showing an association of diabetes with greater weight loss and greater pulmonary inflammation, with macrophage infiltrates similar to those seen clinically in the disease.…”

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

“…Overtreatment, especially with insufficient monitoring, may also lead to adverse events such as hypoglycemia, hypotension, or drug-drug interactions. However, given the multiple morbidities associated with diabetes, the high costs of cardiovascular-kidney complications, notably kidney failure, 365 and the proven benefits of control of cardiometabolic and lifestyle risk factors on these outcomes, 6,350,366 the Work Group judged that this upfront investment is likely to be translated to long-term benefits.…”

Commentary: COVID-19 in patients with diabetes

“…To date, there have been only limited experimental studies directly addressing the role of hyperglycemia in the pathogenesis and prognosis of viral respiratory diseases [5][6][7][8] . However, it has been shown that elevated blood glucose levels can directly increase glucose concentrations in airway secretion.…”