Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data
Open accessAbstract
Background Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes.Methods In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR).Findings In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources.Interpretation All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes.Funding US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
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The Swedish National Diabetes Registry revealed a clear improvement of clinical outcomes by each risk factor within the target range (HbA1c, LDL-C, albuminuria, smoking, and SBP).
“The Swedish National Diabetes Registry revealed a clear improvement of clinical outcomes by each risk factor within the target range (HbA1c, LDL-C, albuminuria, smoking, and SBP).360”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [360]
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“81,82 In addition to the estimates presented here, previous studies have reported global diabetes estimates from earlier rounds of GBD, and two other organisations, the IDF and NCD-RisC, have also generated global and multi-country estimates of diabetes for specific age groups.”
Self-citation2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
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- Authors
- Magliano, D. J., Chen, L., Carstensen, B., Gregg, E. W., Pavkov, M. E., Salim, A., Andes, L. J., Balicer, R., Baviera, M., Chan, J. C. N., Cheng, Y. J., Gardiner, H., Gulseth, H. L., Gurevicius, R., Ha, K. H., Jermendy, G., Kim, D. J., Kiss, Z., Leventer-Roberts, M., Lin, C.-Y., Luk, A. O. Y., Ma, S., Mata-Cases, M., Mauricio, D., Nichols, G. A., Pildava, S., Porath, A., Read, S. H., Robitaille, C., Roncaglioni, M. C., Lopez-Doriga Ruiz, P., Wang, K.-L., Wild, S. H., Yekutiel, N., & Shaw, J. E.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Steno Diabetes Center Copenhagen (DK)
- Imperial College London (GB)
- Centers for Disease Control and Prevention (US)
- Clalit Health Services (IL)
- Mario Negri Institute for Pharmacological Research (IT)
- Chinese University of Hong Kong (HK)
- Norwegian Institute of Public Health (NO)
- Ajou University (KR)
- Bajcsy-Zsilinszky Kórház és Rendelőintézet (HU)
- University of Pecs (HU)
- Taipei Veterans General Hospital (TW)
- Ministry of Health (SG)
- Kaiser Permanente Center for Health Research (US)
- Ben-Gurion University of the Negev (IL)
- University of Edinburgh (GB)
- Public Health Agency of Canada (CA)
- Maccabi Healthcare Services (IL)
- Corresponding author
- Magliano, Dianna J
- ORCID
- Magliano, Dianna J
- Chen, Lei
- Carstensen, Bendix
- Gregg, Edward W
- Pavkov, Meda E
- Salim, Agus
- Balicer, Ran
- Baviera, Marta
- Chan, Juliana C N
- Cheng, Yiling J
- Gulseth, Hanne L
- Ha, Kyoung Hwa
- Jermendy, György
- Kim, Dae Jung
- Kiss, Zoltán
- Luk, Andrea O Y
- Ma, Stefan
- Nichols, Gregory A
- Pildava, Santa
- Read, Stephanie H
- Roncaglioni, Maria Carla
- Wang, Kang-Ling
- Wild, Sarah H
- Yekutiel, Naama
- Shaw, Jonathan E
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 10
- Issue
- 2
- Pages
- 112-119
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC11318037
- OpenAlex
- W4205160401
- Cited by
- 91
- References
- 39
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 29 · 2023: 19 · 2022: 15
- FWCI
- 14.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- AJOU Open Repository (Ajou University) (submittedVersion)
- Funders
- Diabetes Australia
- Hospital Authority
- Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
- Centers for Disease Control and Prevention (Y18G-MAGD)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, all-cause mortality, excess mortality, mortality trends, type 2 diabetes, standardized mortality ratio, high-income countries, mortality decline, health policy evaluation, Asia, Europe, North America, Australia, South Korea, Hong Kong, Singapore, Taiwan, Medicare, administrative health data, health insurance
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Humans, Income, National Health Programs, Registries, Retrospective Studies
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