Top

Published in:

01-04-2020 | Pneumonia | Article

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

Authors: Hongjiang Wu, Eric S. H. Lau, Ronald C. W. Ma, Alice P. S. Kong, Sarah H. Wild, William Goggins, Elaine Chow, Wing-Yee So, Juliana C. N. Chan, Andrea O. Y. Luk

Published in: Diabetologia | Issue 4/2020

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.

Available only for authorised users

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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

10.

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

11.

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

12.

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

13.

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

14.

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 CrossRefPubMed

15.

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

16.

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 CrossRefPubMed

17.

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 CrossRefPubMed

18.

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 CrossRefPubMed

19.

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 CrossRefPubMed

20.

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

21.

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 CrossRef

22.

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

23.

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 CrossRef

24.

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 CrossRefPubMed

25.

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 CrossRefPubMed

26.

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 CrossRefPubMed

27.

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 CrossRef

28.

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 CrossRefPubMed

29.

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

30.

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

31.

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 CrossRefPubMedPubMedCentral

32.

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 CrossRef

33.

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 CrossRefPubMedPubMedCentral

34.

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

Title: Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study
Authors: Hongjiang Wu
Eric S. H. Lau
Ronald C. W. Ma
Alice P. S. Kong
Sarah H. Wild
William Goggins
Elaine Chow
Wing-Yee So
Juliana C. N. Chan
Andrea O. Y. Luk
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keyword: Pneumonia
Published in: Diabetologia / Issue 4/2020
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-05074-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 4/2020

An adipocyte-specific defect in oxidative phosphorylation increases systemic energy expenditure and protects against diet-induced obesity in mouse models

Serum 25-hydroxyvitamin D concentration in childhood and risk of islet autoimmunity and type 1 diabetes: the TRIGR nested case–control ancillary study

Neuronal control of peripheral nutrient partitioning

Impact of sleep deprivation and high-fat feeding on insulin sensitivity and beta cell function in dogs

Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention, irrespective of changes in cardiorespiratory fitness

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page