All-cause and cardiorenal mortality in 6 million adults with and without type 2 diabetes : A comparative, trend analysis in Canada, Spain, and the UK
Ling, Suping (London School of Hygiene and Tropical Medicine)
Zaccardi, Francesco (University of Leicester)
Vlacho, Bogdan (Institut d'Investigació Biomèdica Sant Pau)
Li, Ping (Institute for Clinical Evaluative Sciences (ICES))
Real, Jordi (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas)
Mata-Cases, Manel (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Franch-Nadal, Josep (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Kosiborod, Mikhail N. (University of Missouri)
Gillies, Clare (University of Leicester)
Fenici, Peter (Biomagnetism and Clinical Physiology International Center (BACPIC))
Mauricio Puente, Dídac (Institut d'Investigació Biomèdica Sant Pau)
Shah, Baiju R. (Sunnybrook Health Sciences Centre)
Khunti, Kamlesh (University of Leicester)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	To understand geographical and temporal patterns in the diabetes gap, the excess mortality risk associated with type 2 diabetes (T2D), in three high-income countries. Using databases from Canada (Ontario), Spain (Catalonia) and the UK (England), we harmonized the study design and the analytical strategy to extract information on subjects aged over 35 years with incident T2D between 1998 and 2018 matched to up to five subjects without diabetes. We used Poisson models to estimate age-specific mortality trends by diabetes status and rate ratios and rate differences associated with T2D. In more than 6 million people, 694 454 deaths occurred during a follow-up of 52 million person-years. Trends in all-cause mortality rates differed between Ontario and England; yet, the diabetes gaps were very similar in recent years: in 2018, we estimated 1. 3 (95% confidence interval: 0. 8, 1. 8) and 0. 8 (0. 2, 1. 5) more deaths per 1000 person-years in 50-year-old men with diabetes in Ontario and England, respectively, and 8. 9 (6. 1, 11. 7) and 12. 1 (9. 1, 15. 1) in 80-year-old men; between-country differences were small also in women. In Catalonia, rate ratios comparing T2D with no diabetes in men in 2018 were 1. 53 (1. 11, 2. 11) at 50 years old, 0. 88 (0. 72, 1. 06) at 60 years old, 0. 74 (0. 60, 0. 90) at 70 years old and 0. 81 (0. 66, 1. 00) at 80 years old, indicating lower mortality rates in men with T2D from the age of 60 years; rates were similar in women with and without diabetes at all ages. The diabetes gaps in cardiorenal mortality mirrored those of all-cause mortality: we observed consistent reductions in the proportions of cardiorenal deaths in subjects aged 80 years but variations in subjects aged ≤70 years, regardless of the presence of diabetes. By reducing the confounding impact of epidemiological and analytical differences, this study showed geographical similarities and differences in the diabetes gap: an excess risk of all-cause and cardiorenal mortality in subjects with T2D is still present in Ontario and England in recent years, particularly in elderly subjects. Conversely, there were very small gaps in young men with T2D or even lower mortality rates in older subjects with T2D in Catalonia.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	All-cause mortality ; Cardiorenal mortality ; Electronic health records data ; Multinational study ; Trend analysis ; Type 2 diabetes
Publicat a:	Diabetes, Obesity and Metabolism, Vol. 25 Núm. 1 (january 2023) , p. 132-143, ISSN 1463-1326

DOI: 10.1111/dom.14856
PMID: 36056765

12 p, 1.8 MB

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