The aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016.
The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes.
Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45–74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20–44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change [AAPC]: −3.2% [95% CI −7.3%, 1.0%]) and women (AAPC: −1.2% [95% CI −6.5%, 4.4%]). The SMRs in people aged 20−44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016.
Absolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.
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The data supporting the findings of this study are available on request from the corresponding author (AOYL).
Average annual per cent change
Annual per cent change
Hong Kong Diabetes Surveillance Database
Standardised mortality ratio
World Health Organization (2018) Global health estimates 2016: deaths by cause, age, sex, by country and by region, 2000–2016. Geneva, World Health Organization. Available from www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html. Accessed 8 Dec 2019
Emerging Risk Factors Collaboration (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 364(9):829–841. https://doi.org/10.1056/NEJMoa1008862
Harding JL, Shaw JE, Peeters A, Davidson S, Magliano DJ (2016) Age-specific trends from 2000–2011 in all-cause and cause-specific mortality in type 1 and type 2 diabetes: a cohort study of more than one million people. Diabetes Care 39(6):1018–1026. https://doi.org/10.2337/dc15-2308
Read SH, Kerssens JJ, McAllister DA et al (2016) Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Diabetologia 59(10):2106–2113. https://doi.org/10.1007/s00125-016-4054-9
Gregg EW, Cheng YJ, Srinivasan M et al (2018) Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet 391(10138):2430–2440. https://doi.org/10.1016/S0140-6736(18)30314-3
Lind M, Garcia-Rodriguez L, Booth G et al (2013) Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study. Diabetologia 56(12):2601–2608. https://doi.org/10.1007/s00125-013-3063-1
Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW (2019) Global trends in diabetes complications: a review of current evidence. Diabetologia 62(1):3–16. https://doi.org/10.1007/s00125-018-4711-2
Quan J, Li T, Pang H et al (2017) Diabetes incidence and prevalence in Hong Kong, China during 2006-2014. Diabet Med 34(7):902–908. https://doi.org/10.1111/dme.13284
The World Bank (2019) Life expectancy at birth, total (years). Available from https://data.worldbank.org/indicator/SP.DYN.LE00.IN. Accessed 16 May 2019
The Government of the Hong Kong Special Administrative Region’s Census and Statistics Department (2018) 2016 population by-census. Available from www.censtatd.gov.hk/hkstat/sub/so459.jsp. Accessed 1 July 2019
Hospital Authority (2019) Clusters, hospitals and institutions. Available from www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10036&Lang=ENG&Dimension=100&Parent_ID=10004. Accessed 6 Oct 2019
Hospital Authority (2017) Hospital Authority annual report 2015–2016. Available from www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=235572&Lang=ENG. Accessed 6 Oct 2019
Chiang CL (1968) The life table and its construction. Introduction to stochastic process in biostatistics. John Wiley And Sons, Inc, New York, pp 189–214
Harding JL, Shaw JE, Peeters A, Guiver T, Davidson S, Magliano DJ (2014) Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997-2010. Diabetes Care 37(9):2579–2586. https://doi.org/10.2337/dc14-0096
The Government of the Hong Kong Special Administrative Region’s Education Bureau (2016) Healthcare system. Available from www.edb.gov.hk/attachment/en/curriculum-development/kla/technology-edu/resources/hmsc/HMSC_Booklet10_E_p52.pdf. Accessed 11 July 2019
Luk AO, Hui EM, Sin M et al (2017) Declining trends of cardiovascular–renal complications and mortality in type 2 diabetes: the Hong Kong Diabetes Database. Diabetes Care 40(7):928–935. https://doi.org/10.2337/dc16-2354
Wan EYF, Fung CSC, Jiao FF et al (2018) Five-year effectiveness of the multidisciplinary Risk Assessment and Management Programme—Diabetes Mellitus (RAMP-DM) on diabetes-related complications and health service uses—a population-based and propensity-matched cohort study. Diabetes Care 41(1):49–59. https://doi.org/10.2337/dc17-0426
Chan JCN, Lim L-L, Luk AOY et al (2019) From Hong Kong Diabetes Register to JADE Program to RAMP-DM for data-driven actions. Diabetes Care 42(11):2022–2031. https://doi.org/10.2337/dci19-0003
Ko G, Tang J, Chan J (2010) Worsening trend of central obesity despite stable or declining body mass index in Hong Kong Chinese between 1996 and 2005. Eur J Clin Nutr 64(5):549–552. https://doi.org/10.1038/ejcn.2010.49
The Government of the Hong Kong Special Administrative Region’s Department of Health’s Centre for Health Protection (2019) Statistics on behavioural risk factors. Available from www.chp.gov.hk/en/static/24016.html. Accessed 4 June 2019
Abarca-Gómez L, Abdeen ZA, Hamid ZA et al (2017) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 390(10113):2627–2642. https://doi.org/10.1016/S0140-6736(17)32129-3
The Government of the Hong Kong Special Administrative Region’s Department of Health’s Tobacco and Alcohol Control Office (2018) Pattern of smoking in Hong Kong. Available from www.taco.gov.hk/t/english/infostation/infostation_sta_01.html. Accessed 4 June 2019
Leung CB, Cheung WL, Li PKT (2015) Renal registry in Hong Kong—the first 20 years. Kidney Int Suppl 5(1):33–38. https://doi.org/10.1038/kisup.2015.7
Yeung RO, Zhang Y, Luk A et al (2014) Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort. Lancet Diabetes Endocrinol 2(12):935–943. https://doi.org/10.1016/S2213-8587(14)70137-8
Chan JC, Lau ES, Luk AO et al (2014) Premature mortality and comorbidities in young-onset diabetes: a 7-year prospective analysis. Am J Med 127(7):616–624. https://doi.org/10.1016/j.amjmed.2014.03.018
Ke C, Lau E, Shah BR et al (2019) Excess burden of mental illness and hospitalization in young-onset type 2 diabetes: a population-based cohort study. Ann Intern Med 170(3):145–154. https://doi.org/10.7326/M18-1900
Khalil CA, Roussel R, Mohammedi K, Danchin N, Marre M (2012) Cause-specific mortality in diabetes: recent changes in trend mortality. Eur J Prev Cardiol 19(3):374–381. https://doi.org/10.1177/1741826711409324
So WY, Yang X, Ma RC et al (2008) Risk factors in V-shaped risk associations with all-cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry. Diabetes Metab Res Rev 24(3):238–246. https://doi.org/10.1002/dmrr.792
Lam T, Leung P, Foo W, et al. (2004) Recommendations of Cancer Expert Working Group on cancer prevention and screening–an overview for health professionals. Department of Health, Hong Kong. Available from www.chp.gov.hk/files/pdf/overview_of_cewg_recommendations_professional_hp.pdf. Accessed 8 Dec 2019
The Government of the Hong Kong Special Administrative Region’s Department of Health’s Centre for Health Protection (2019) Number of deaths by leading causes of death, 2001–2018. Available from www.chp.gov.hk/en/statistics/data/10/27/380.html. Accessed 22 Apr 2019
Rampatige R, Mikkelsen L, Hernandez B, Riley I, Lopez AD (2014) Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers. Bull World Health Organ 92(11):807–816. https://doi.org/10.2471/BLT.14.137935
Zhao J, Tu EJ-C, Law C-K (2017) The incomparability of cause of death statistics under “one country, two systems”: Shanghai versus Hong Kong. Popul Health Metrics 15(1):37. https://doi.org/10.1186/s12963-017-0155-z
Wu H, Lau ES, Kong AP et al (2018) Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the joint Asia diabetes evaluation program. Clin Epidemiol 10:1561–1571. https://doi.org/10.2147/CLEP.S177437
The Government of the Hong Kong Special Administrative Region’s, Census and Statistics Department (2017) Hong Kong population projections 2017–2066. Available from www.statistics.gov.hk/pub/B1120015072017XXXXB0100.pdf. Accessed 19 Nov 2019
We acknowledge the Hong Kong Hospital Authority for providing anonymised clinical data for research.
HW is partially supported by a research grant from the Asia Diabetes Foundation.
The authors declare that there is no duality of interest associated with this manuscript.
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Wu, H., Lau, E.S.H., Ma, R.C.W. et al. Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study. Diabetologia (2020). https://doi.org/10.1007/s00125-019-05074-7
- All-cause mortality
- Cause-specific mortality
- Standardised mortality ratios