Repository logo
 

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

Published version
Peer-reviewed

Repository DOI


Type

Article

Change log

Authors

Kaptoge, S 
Seshasai, SRK 
Sun, L 
Walker, M 
Bolton, T 

Abstract

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 highincome 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.

Description

Keywords

3205 Medical Biochemistry and Metabolomics, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 3 Good Health and Well Being

Journal Title

The Lancet Diabetes & Endocrinology

Conference Name

Journal ISSN

2213-8587
2213-8595

Volume Title

Publisher

Elsevier BV
Sponsorship
British Heart Foundation (RG/18/13/33946)
British Heart Foundation (RE/18/1/34212)
British Heart Foundation (CH/12/2/29428)
British Heart Foundation (CH/12/2/29428)
National Institute for Health and Care Research (IS-BRC-1215-20014)
ESRC (ES/T013192/1)