The aim of this study was to determine the contemporary rate ratio of mortality and changes over time in individuals with vs without diabetes.
Annual age- and sex-adjusted mortality rates were compared for adults (>20 years) with and without diabetes in Ontario, Canada, and the UK from January 1996 to December 2009 using The Health Improvement Network (THIN) and Ontario databases. The total number of individuals evaluated increased from 8,757,772 in 1996 to 12,696,305 in 2009.
The excess risk of mortality for individuals with diabetes in both cohorts was significantly lower during later vs earlier years of the follow-up period (1996–2009). In Ontario the diabetes mortality rate ratio decreased from 1.90 (95% CI 1.86, 1.94) in 1996 to 1.51 (1.48, 1.54) in 2009, and in THIN from 2.14 (1.97, 2.32) to 1.65 (1.57, 1.72), respectively. In Ontario and THIN, the mortality rate ratios among diabetic patients in 2009 were 1.67 (1.61, 1.72) and 1.81 (1.68, 1.94) for those aged 65–74 years and 1.11 (1.10, 1.13) and 1.19 (1.14, 1.24) for those aged over 74 years, respectively. Corresponding rate ratios in Ontario and THIN were 2.45 (2.36, 2.54) and 2.64 (2.39, 2.89) for individuals aged 45–64 years, and 4.89 (4.35, 5.45) and 5.18 (3.73, 6.69) for those aged 20–44 years.
The excess risk of mortality in individuals with vs without diabetes has decreased over time in both Canada and the UK. This may be in part due to earlier detection and higher prevalence of early diabetes, as well as to improvements in diabetes care.
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Ontario Diabetes Database
The Health Improvement Network
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J. Murphy, an independent consultant, based in Kansas City, KS, USA, assisted in language editing of a first draft of the manuscript. S. Dahlqvist from the NU-Hospital Organization assisted in manuscript preparation. The authors thank P. Li (Institute for Clinical Evaluative Sciences) for assistance with statistical analyses and V. Urosevic (Women’s College Research Institute) for assistance with manuscript preparation and data presentation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. This study was supported through provision of data by the Institute for Clinical Evaluative Sciences (ICES) and through funding support to ICES from an annual grant by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors. No endorsement by ICES or the Government of Ontario is intended or should be inferred.
This study was supported by the National Diabetes Surveillance System funding from Ontario’s Ministry of Health and Long-Term Care and an unrestricted grant from AstraZeneca and Novo Nordisk Scandinavia. The NU-Hospital Organization supports ML for research. LLL was supported by the Canadian Diabetes Association/Canadian Institute of Health Research (CDA/CIHR) Clinician Scientist Award, and currently receives support from a CIHR New Investigator Award. BRS receives support from the CDA, CIHR and the Banting and Best Diabetes Centre at the University of Toronto. GLB is supported by a new investigator award from the Ontario Women’s Health Council and CIHR and by a Helene and Reuben Dennis Scholar Award from the Banting and Best Diabetes Centre at the University of Toronto.
The funding agencies had no role in the original protocol design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the report for publication.
Duality of interest
ML has received honoraria or served as a consultant for Bayer, Eli Lilly, Novartis, Novo Nordisk Scandinavia, Medtronic Pfizer and Sanofi and has been a member of an advisory board for Novo Nordisk Scandinavia. ML’s institution (NU-Hospital Organization) has received grants from Abbot Scandinavia, AstraZeneca and Novo Nordisk Scandinavia. CEIFE has received research grants from AstraZeneca and Bayer. Other authors declare that there is no duality of interest associated with their contribution to this manuscript.
ML, LAGR, GLB, BRS and LLL designed the study protocol. ML, LAGR, LCS and GE performed the statistical analyses. ML and LLL wrote a draft of the manuscript. All authors participated in reviewing and finalising the report. ML had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of the manuscript.
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Lind, M., Garcia-Rodriguez, L.A., Booth, G.L. et al. Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study. Diabetologia 56, 2601–2608 (2013). https://doi.org/10.1007/s00125-013-3063-1