Mortality rates decline among middle-aged, older adults with diabetes in Hong Kong
Adults with diabetes living in Hong Kong, particularly those older than 45 years, saw a drop in mortality due to all-causes, cardiovascular disease and cancer between 2001 and 2016, according to findings published in Diabetologia.
“Understanding all-cause and cause-specific mortality trends in diabetes is important to evaluate the impact of provision of diabetes care, identify the changing patterns in causes of death and inform decision-makers in developing new health care strategies to address unmet needs,” Andrea O.Y. Luk, MBChB, FHKCP, FHKAM, an associate professor in the department of medicine and therapeutics and a specialist in endocrinology, diabetes and metabolism at the Chinese University of Hong Kong, and colleagues wrote.
Luk and colleagues assessed 2001 to 2016 mortality data from 390,071 men and 380,007 women with diabetes in electronic medical records from the Hong Kong Hospital Authority.
There was a 53.5% reduction in all-cause mortality for women with diabetes between 2001 and 2016 and a 52.3% reduction for men with diabetes, although the researchers noted that “the declines ... were not statistically significant” for those younger than 45 years. In addition, women with diabetes had an all-cause standardized mortality ratio (SMR) of 1.67 (95% CI, 1.62-1.72) vs. those without diabetes in 2016 and an SMR of 3.28 (95% CI, 3.15-3.41) in 2001. Men with diabetes had an all-cause SMR of 1.5 (95% CI, 1.46-1.54) vs. those without diabetes in 2016 and an SMR of 2.82 (95% CI, 2.72-2.94) in 2001. However, the researchers noted that “SMRs fluctuated over time” for those younger than 45 years.
“The less marked improvements in all-cause mortality rates among young people in Hong Kong and in other regions is concerning since these individuals are at the prime age of economic productivity and the high rates of premature mortality are expected to have major societal impacts,” the researchers wrote. “However, it is important to note that the nonstatistically significant changes in all-cause mortality rates and imprecise SMRs in young people may, in part, be due to the small number of deaths in this age group.”
Beyond all-cause mortality, among women with diabetes, there was a 78.5% reduction in CVD mortality, and among men, there was a 72.2% reduction. Additionally, among women with diabetes, there was a 59.6% reduction in cancer mortality, and among men, there was a 65.1% reduction. However, mortality related to pneumonia was unaffected, according to the researchers.
“The different patterns of changes in cause-specific mortality rates resulted in a shift in the leading cause of death from CVD to pneumonia in the whole group,” the researchers wrote.
The researchers further noted that women with diabetes had a mean HbA1c of 7.3% in 2016 vs. 7.7% in 2001, whereas men had a mean HbA1c of 7.4% in 2016 vs. a 7.8% in 2001.
“We revealed major declines in mortality rates from all-causes, CVD and cancer, and in mortality relative to the nondiabetic population in men and women with diabetes in Hong Kong between 2001 and 2016,” the researchers wrote. “The multiple policy and system changes introduced in response to the growing prevalence of diabetes in Hong Kong might have contributed to these secular changes and may serve as a reference for other developing regions facing similar challenges.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.