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Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study

Abstract

Aims/hypothesis

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.

Methods

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.

Results

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.

Conclusions/interpretation

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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Data availability

The data supporting the findings of this study are available on request from the corresponding author (AOYL).

Abbreviations

AAPC:

Average annual per cent change

APC:

Annual per cent change

CVD:

Cardiovascular disease

HKDSD:

Hong Kong Diabetes Surveillance Database

SMR:

Standardised mortality ratio

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Acknowledgements

We acknowledge the Hong Kong Hospital Authority for providing anonymised clinical data for research.

Funding

HW is partially supported by a research grant from the Asia Diabetes Foundation.

Author information

All authors made substantial contributions to conception and design, revised the article critically for important intellectual content and approved the final version to be published. HW additionally contributed to analysis and interpretation of data, and drafted the article. AOYL additionally contributed to acquisition of data. AOYL is the guarantor of this work, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Correspondence to Andrea O. Y. Luk.

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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

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Keywords

  • All-cause mortality
  • Cause-specific mortality
  • Diabetes
  • Standardised mortality ratios
  • Trends