Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records.
Level 3 - non-randomized controlled study
Non-randomized matched cohort study using linked longitudinal primary care and mortality records
PubMed 33549162 · doi:10.1016/S2213-8587(20)30431-9
What was done
Researchers analyzed linked primary care records from the Clinical Practice Research Datalink and UK Office for National Statistics mortality records from 2001 to 2018 in England. They identified 313,907 individuals with diagnosed diabetes and matched them 1:1 by age and sex to individuals without diabetes (total n = 627,814). Using discretised Poisson regression models across serial cross-sections with longitudinal follow-up, they estimated annual all-cause mortality and cause-specific mortality across 12 cause categories for men and women.
What was found
Between January 1, 2001, and October 31, 2018, total mortality declined by 32% in men (from 40.7 to 27.8 deaths per 1,000 person-years) and by 31% in women (from 42.7 to 29.5 deaths per 1,000 person-years) with diagnosed diabetes. Similar declines occurred in individuals without diabetes, keeping the mortality gap between the two groups constant. Cause-specific mortality decreased in 10 of 12 categories, with increases observed only for dementia and liver disease in both populations. Due to the large drop in vascular deaths, cancer surpassed vascular disease as the leading contributor to mortality and to the excess mortality gap in people with diabetes.
Why it matters
This study documents an epidemiological shift in the mortality profile of diabetes from predominantly cardiovascular causes to cancer, dementia, and liver disease. Preventive and clinical management strategies must broaden beyond traditional vascular risk reduction to address these emerging leading causes of death.
Limits
The study is observational and restricted to English primary care records, which may limit generalizability to other healthcare settings. The abstract does not report stratification by diabetes subtype (type 1 versus type 2) or adjustments for glycemic control, pharmacological regimens, or behavioral risk factors. Cause-of-death attribution was based on death certificate data, which is subject to diagnostic and coding inaccuracies.
Cited by
- supports Cancer is a rising cause of mortality among people diagnosed with diabetes.