Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

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Background: The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. Methods: For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961–2007, median latest follow-up years 1980–2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. Findings: For participants with diabetes, we observed a linear dose–response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43–2·97) when diagnosed at 30–39 years, 2·26 (2·08–2·45) at 40–49 years, 1·84 (1·72–1·97) at 50–59 years, 1·57 (1·47–1·67) at 60–69 years, and 1·39 (1·29–1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. Interpretation: Every decade of earlier diagnosis of diabetes was associated with about 3–4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. Funding: British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

TidsskriftThe Lancet Diabetes and Endocrinology
Udgave nummer10
Sider (fra-til)731-742
Antal sider12
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
This research was conducted using the UK Biobank Resource under application number 13784. No specific funding was obtained for this manuscript. The coordinating centre was supported by core funding from the British Heart Foundation (RG/18/13/33946), Cambridge BHF Centre of Research Excellence (RE/18/1/34212) and BHF Chair Award (CH/12/2/29428), and NIHR Cambridge Biomedical Research Centre (BRC-1215-20014; NIHR203312). JD holds a BHF Professorship and an NIHR Senior Investigator Award. AMW is part of the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement 116074 and is supported by the BHF-Turing Cardiovascular Data Science Award (BCDSA\100005). MI is supported by the Munz Chair of Cardiovascular Prediction and Prevention and by the UK Economic and Social Research 878 Council (ES/T013192/1). EDA holds a NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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