Abstract
BackgroundTo investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes.MethodsA cohort of 17,203 patients with type 1 diabetes were identified from Taiwan’s National Health Insurance claims in the period of 1998–2014. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population.ResultsIn up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The all-cause SMR was significantly elevated at 4.16 (95% confidence interval, 4.04–4.28), with a greater all-cause SMR noted in females than in males (4.62 vs 3.79). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15–24 years (SMR, 8.46).ConclusionsType 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.
Highlights
A meta-analysis of the relative risk (RR) of mortality for type 1 diabetes compared with the general population that included 26 studies with 88 sub-populations found that the overall RR of mortality was 3.82 (95% confidence interval [CI], 3.41–4.29) compared with the general population.[9]
Diabetes was the leading underlying cause of death (UCOD) (n = 1,482), which accounted for 30.15% of the total deaths, followed by cancer (n = 1,007, 20.48%), circulatory diseases (n = 646, 13.14%) and renal diseases (n = 563, 11.45%)
The distributions of UCODs varied with age at death, in which the proportion of deaths from violence or accidents and diabetes were considerably higher in children (0–14 years) than in patients of older age groups
Summary
Type 1 diabetes mellitus is associated with a high risk of premature death from various acute and chronic causes.[1,2,3] Causes of death in children and young adults with type 1 diabetes are mainly related to acute diabetic complications; the main cause of death in adulthood is related to long-term complications, cardiovascular disease (CVD).[4,5] the risk of mortality in individuals with type 1 diabetes remains elevated, a declined trend in mortality of type 1 diabetes population was noted in many parts of the world, such as Norway, Australia, and Sweden.[6,7,8] A meta-analysis of the relative risk (RR) of mortality for type 1 diabetes compared with the general population that included 26 studies with 88 sub-populations found that the overall RR of mortality was 3.82 (95% confidence interval [CI], 3.41–4.29) compared with the general population.[9]. To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). Conclusions: Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease
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