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Excess mortality in Type 1 diabetes diagnosed in childhood and adolescence: a systematic review of population-based cohorts

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Abstract

Aims

Systematic review of mortality in childhood-/adolescent-diagnosed Type 1 diabetes and examination of factors explaining the mortality variation between studies.

Methods

Relevant studies were identified from systematic searches of MEDLINE and EMBASE. Observed and expected numbers of deaths were extracted, and standardised mortality ratios (SMRs) and 95 % confidence intervals (CIs) were calculated. Negative binomial regression was used to investigate association between mortality and study/country characteristics.

Results

Thirteen relevant publications with mortality data were identified describing 23 independent studies. SMRs varied markedly ranging from 0 to 854 (χ 2 = 70.68, df = 21, P < 0.0001). Significant associations were observed between SMR and mid-year of follow-up [incidence rate ratio (IRR) 0.95, 95 % CI 0.91–0.99 equivalent to a 5 % decrease per year], between SMR and infant mortality rate (IRR 1.07, 95 % CI 1.02–1.12, a 7 % increase for each death per 1,000 live births) and, after omitting an outlier, between SMR and health expenditure as a percentage of gross domestic product (GDP) (IRR 0.79, 95 % CI 0.68–0.93, a 21 % decrease for each one percent increase in GDP). No relationship was detected between SMR and a country’s childhood diabetes incidence rate or GDP.

Conclusions

Excess mortality in childhood-/adolescent-diagnosed Type 1 diabetes is apparent across countries worldwide. Excesses were less marked in more recent studies and in countries with lower infant mortality and higher health expenditure.

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Abbreviations

SMR:

Standardised mortality ratio

GDP:

Gross domestic product

IRR:

Incidence rate ratio

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Acknowledgments

EM and CB independently reviewed the studies from the searches. CCP contributed to discussion on the final set of studies to be included in the review. EM, CCP and CRC contributed to the analyses and interpretation of the data and drafted and revised the manuscript. DRM commented and revised the manuscript. All authors gave final approval to the published version of this paper. EM is a PhD candidate at Queen’s University Belfast and EM is funded by the Centre of Excellence for Public Health (Northern Ireland), a UKCRC Public Health Research Centre of Excellence.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This is a review article and does not contain original data on human or animal subjects.

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Authors and Affiliations

  1. Institute of Clinical Sciences B, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK

    Eileen Morgan, Christopher R. Cardwell, Catherine J. Black & Christopher C. Patterson

  2. Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK

    David R. McCance

Authors
  1. Eileen Morgan
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  2. Christopher R. Cardwell
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  3. Catherine J. Black
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  4. David R. McCance
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  5. Christopher C. Patterson
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Corresponding author

Correspondence to Christopher C. Patterson.

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Morgan, E., Cardwell, C.R., Black, C.J. et al. Excess mortality in Type 1 diabetes diagnosed in childhood and adolescence: a systematic review of population-based cohorts. Acta Diabetol 52, 801–807 (2015). https://doi.org/10.1007/s00592-014-0702-z

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  • DOI: https://doi.org/10.1007/s00592-014-0702-z

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