Changing Patterns in temporal trends of diabetes mortality in China from 1987-2020: a rapid growth among rural populations

Abstract

Diabetes mellitus (DM) is a public health challenge in China. Quantifying changes in DM mortality is of great significance, but related evidence of Chinese older adults is scarce. This study conducted a comprehensive analysis of China’s DM mortality changing trajectory. The data from 1987 to 2020 was derived from the National Health Commission of China. Joinpoint analysis and age-period-cohort (APC) model were used to calculate the annual change and the effects of age, period and cohort on DM mortality. The changing trajectory from 1987 to 2020 showed an upward trend, especially among rural groups, and the gap between rural-urban narrowed. Joinpoint analysis showed a consistent upward trend in rural areas (4.9%, 95%CI: 4.0%-5.7%). However, the urban showed an upward trend from 1987–1998 (5.7%) and a slow downward trend from 1998 to 2020 (-1.0%). The APC model showed that the reporting rate increased with age in urban and rural areas. For the effect of time period and cohort, as they proceeded, the rural showed a consistent and significant upward trend, but the trends in urban remained relatively stable. The DM mortality in China has shown an overall upward trend over the past three decades, especially in rural areas. Although the gap between urban-rural has been further reduced, the burden of the oldest-older has risen significantly regardless of areas. It is time to give priority attention to the high mortality of DM among females, the elderly and rural areas, and the government should take measures to curb this trend.