medwireNews: Almost all diabetes-related deaths in people younger than 25 years occur in countries that fall in the lower end of the Socio-demographic Index (SDI), report the GBD 2019 Diabetes Mortality Collaborators.
However, they found a large amount of variability between countries within the same SDI groupings, much of which was explained by the existence or otherwise of universal health coverage.
“It is time for insulin, now 100 years after its discovery, to become available to all in need,” Ewerton Cousin (University of Washington, Seattle, USA) and collaborators from the GBD (Global Burden of Diseases, Injuries, and Risk Factors) Study write in The Lancet Diabetes & Endocrinology.
The SDI is based on the fertility rate in young women, plus per capita education and income. In all, 97.5% of the 16,300 deaths due to type 1 or 2 diabetes that occurred in 204 countries and territories among people younger than 25 years in 2019 were in countries falling into the low or low-middle two-fifths of this scale.
Nearly three-quarters of all deaths were attributed to type 1 diabetes, and 16.5% to chronic kidney disease caused by either type 1 or type 2 diabetes.
The global age-standardized rate of death from diabetes fell by 17.0% between 1990 and 2019, although several countries had an increase, including Pakistan, Guatemala, Uzbekistan, and Mauritius. The largest reduction, of 44.5%, occurred in the high-middle SDI quintile and the smallest reduction, of 13.6%, in the lowest quintile. There were larger decreases in type 1 diabetes mortality than in deaths from type 2 diabetes.
The collaborators found that the greater the amount of healthcare coverage available in a country, the lower was its age-standardized diabetes-related mortality rate in the under 25s. This factor explained 62% of the total variability in mortality.
In a linked commentary, Henrik Toft Sørensen (Aarhus University Hospital, Denmark) notes that the study “confirms that health inequalities are substantial.”
He writes: “The findings of this analysis of GBD 2019 data illustrate the urgent need for efforts to implement the UN’s and the WHO’s goal for universal access to health care and affordable essential medications for diabetes and other chronic diseases.
“Health services research and subsequent policy initiatives are required to reduce the current barriers.”
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Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(21)00349-1
Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00009-2