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Cited by 68Diabetes Management and ResearchDiabetes and associated disordersDiabetes, Cardiovascular Risks, and Lipoproteins

Mortality trends in type 1 diabetes: a multicountry analysis of six population-based cohorts

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Ruiz, Paz L. D., Chen, Lei, Morton, Jedidiah I., Salim, Agus, Carstensen, Bendix, Gregg, Edward W., Pavkov, Meda E., Mata-Cases, Manel +7 more·2022·Diabetologia
DOI 10.1007/s00125-022-05659-9PMC PMC9076725
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Abstract

Aims/hypothesis: Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. Methods: We assembled aggregate data on all-cause mortality during the period 2000–2016 in people with type 1 diabetes aged 0–79 years from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and the USA (Kaiser Permanente Northwest). Data were obtained from administrative sources, health insurance records and registries. All-cause mortality rates in people with type 1 diabetes, and standardised mortality ratios (SMRs) comparing type 1 diabetes with the non-diabetic population, were modelled using Poisson regression, with age and calendar time as quantitative variables, describing the effects using restricted cubic splines with six knots for age and calendar time. Mortality rates were standardised to the age distribution of the aggregate population with type 1 diabetes. Results: All six data sources showed a decline in age- and sex-standardised all-cause mortality rates in people with type 1 diabetes from 2000 to 2016 (or a subset thereof), with annual changes in mortality rates ranging from −2.1% (95% CI −2.8%, −1.3%) to −5.8% (95% CI −6.5%, −5.1%). All-cause mortality was higher for male individuals and for older individuals, but the rate of decline in mortality was generally unaffected by sex or age. SMR was higher in female individuals than male individuals, and appeared to peak at ages 40–70 years. SMR declined over time in Denmark, Scotland and Spain, while remaining stable in the other three data sources. Conclusions/interpretation: All-cause mortality in people with type 1 diabetes has declined in recent years in most included populations, but improvements in mortality relative to the non-diabetic population are less consistent. Graphical abstract:

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  • In a multi-country study of mortality in type 1 diabetes mellitus from six high-income countries, standardized mortality ratios declined over time (from 2000 to 2016) and with increasing age, but remained >1.0 at all ages examined (40, 50, 60, 70 and 80 years).

    “In a multi-country study of mortality in T1DM from six high-income countries (Spain, Denmark, Australia, Scotland, Latvia and the USA), although SMRs declined over time (from 2000 to 2016) and with increasing age, they remained >1.0 at all ages examined (40, 50, 60, 70 and 80 years)43.”

    From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [43]

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Authors
Ruiz, P. L. D., Chen, L., Morton, J. I., Salim, A., Carstensen, B., Gregg, E. W., Pavkov, M. E., Mata-Cases, M., Mauricio, D., Nichols, G. A., Pildava, S., Read, S. H., Wild, S. H., Shaw, J. E., & Magliano, D. J.
Affiliations
  • Oslo University Hospital (NO)
  • Baker Heart and Diabetes Institute (AU)
  • Steno Diabetes Center Copenhagen (DK)
  • Imperial College London (GB)
  • Centers for Disease Control and Prevention (US)
  • Kaiser Permanente Center for Health Research (US)
  • University of Edinburgh (GB)
Corresponding author
Magliano, Dianna J.
ORCID
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2022-03-22
Volume
65
Issue
6
Pages
964-972
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-022-05659-9
PMC
PMC9076725
OpenAlex
W4220668656
Cited by
68
References
3
Citations by year
2026: 14 · 2025: 13 · 2024: 21 · 2023: 13 · 2022: 7
FWCI
10.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetologia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, cc-by)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • Figshare (submittedVersion, cc-by)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • La Trobe University (cc-by)
Funders
  • Centers for Disease Control and Prevention
  • Victoria State Government Operational Infrastructure Support Program
  • Diabetes Australia
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 1 diabetes, all-cause mortality, mortality trends, standardized mortality ratio, sex differences in mortality, age differences in mortality, population-based cohort, cross-national comparison
MeSH terms
Australia, Diabetes Mellitus, Type 1, Female, Humans, Male, Mortality, Registries, Spain, Age Distribution

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