Endocrinol Metab.  2022 Jun;37(3):466-474. 10.3803/EnM.2022.1440.

Improvement in Age at Mortality and Changes in Causes of Death in the Population with Diabetes: An Analysis of Data from the Korean National Health Insurance and Statistical Information Service, 2006 to 2018

Affiliations
  • 1Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
  • 2Divison of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 3Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 4Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
  • 5Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background
Diabetes is a leading cause of death that is responsible for 1.6 million annual deaths worldwide. However, the life expectancy and age at death of people with diabetes have been a matter of debate.
Methods
The National Health Insurance Service claims database, merged with death records from the National Statistical Information Service in Korea from 2006 to 2018, was analyzed.
Results
In total, 1,432,567 deaths were collected. The overall age at death increased by 0.44 and 0.26 year/year in the diabetes and control populations, respectively. The disparity in the mean age at death between the diabetes and control populations narrowed from 5.2 years in 2006 to 3.0 years in 2018 (p<0.001). In a subgroup analysis according to the presence of comorbid diseases, the number and proportion of deaths remained steady in the group with diabetes only, but steadily increased in the groups with diabetes combined with dyslipidemia and/or hypertension. Compared to the control population, the increase in the mean death age was higher in the population with diabetes. This trend was more prominent in the groups with dyslipidemia and/or hypertension than in the diabetes only group. Deaths from vascular disease and diabetes decreased, whereas deaths from cancer and pneumonia increased. The decline in the proportion of deaths from vascular disease was greater in the diabetes groups with hypertension and/or dyslipidemia than in the control population.
Conclusion
The age at death in the population with diabetes increased more steeply and reached a comparable level to those without diabetes.

Keyword

Mortality; Diabetes mellitus; Cardiovascular diseases; Neoplasms; Epidemiology

Figure

  • Fig. 1. Flow diagram of subject inclusion and exclusion in the Korean National Health Insurance Service (NHIS) claims database and National Statistical Information Service (NSIS).

  • Fig. 2. Changes in age of death among individuals with diabetes and controls. (A) Overall, (B) men, (C) women.

  • Fig. 3. Changes in age of death among controls and individuals with diabetes according to the presence of comorbidities. (A) Overall, (B) men, (C) women. Group I, diabetes only; Group II, diabetes with dyslipidemia; Group III, diabetes with hypertension; Group IV, diabetes with both hypertension and dyslipidemia. Compared to the control population, the increases in the mean death age were higher by 0.16, 0.33, 0.23, and 0.26 year/year for Groups I, II, III, and IV, respectively (all P<0.001).

  • Fig. 4. Age-standardized mortality rate in individuals with diabetes and controls. (A) Control, (B) diabetes.


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Joonyub Lee, Hun-Sung Kim, Kee-Ho Song, Soon Jib Yoo, Kyungdo Han, Seung-Hwan Lee
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