US mortality trends shifting in patients with diabetes
medwireNews: Mortality rates in people with diabetes are falling faster than in those without diabetes, with the greatest decline seen in deaths from vascular causes, US study data show.
However, Edward Gregg (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and co-investigators warn: “The reduction in relative risk of all-cause and vascular-disease death associated with diabetes should not be interpreted as an indication that the public health burden of diabetes is declining.”
They stress that “[o]ne byproduct of the reduction in mortality has been the increase in lifetime risk and years spent with diabetes in the USA.”
Furthermore, the relative risk for all-cause mortality remained more than 60% higher in people with versus without diabetes, and the reduction in the proportion of deaths from vascular causes between 1988 and 2015 was offset by an increase in the proportion of deaths from nonvascular, noncancer causes such as sepsis, influenza, and liver diseases.
Therefore, “[t]he increasing diversification of the causes of death among people with diabetes will have important implications for the development of therapies and public health approaches to reduce diabetes-related morbidity,” Gregg et al remark in The Lancet.
Using data from the National Health Interview Survey Linked Mortality files, the researchers estimated that between the periods 1988–1994 and 2010–2015, all-cause mortality rates among US adults with diabetes fell by 20.1% every 10 years, from 23.1 to 15.2 per 1000 person–years. By comparison, the fall among individuals without diabetes was 10.7% over the same time period.
Vascular-related mortality decreased 31.9% every 10 years (from 11.0 to 5.2 per 1000 person–years) in people with diabetes, while cancer-related deaths fell 15.7% every 10 years (from 4.4 to 3.0 per 1000 person–years). The corresponding decreases in people without diabetes were 25.5% and 11.8%.
The rate of nonvascular, noncancer deaths declined by 8.2% every 10 years (from 7.7 to 7.1 per 1000 person–years) in people with diabetes but increased by 8.3% every 10 years in those without diabetes.
Gregg and team note that differences in the magnitude of changes in cause-specific mortality have resulted in “large changes in the proportional mortality, particularly among adults with diabetes.”
Vascular mortality went from being the biggest cause of death among individuals with diabetes in 1988–1994 (47.8%) to the smallest cause in 2010–2015 (34.1%), while the reverse was true for nonvascular, noncancer deaths, which represented 33.5% of all deaths in 1988–1994 and 46.5% in 2010–2015.
“Given the high prevalence of diabetes and the increased number of years of exposure to diabetes in the US, the diversified causes of mortality could have important clinical and public health effects for diabetes in coming decades, indicating a need to identify and emphasise prevention approaches and epidemiological monitoring of a wider range of diabetes-related morbidity,” Gregg et al conclude.
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group
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