Excess mortality in Type 1 diabetes diagnosed in childhood and adolescence: a systematic review of population-based cohorts

Morgan, Eileen; Cardwell, Christopher; Black, CJ; McCance, David R.; Patterson, Christopher

doi:10.1007/s00592-014-0702-z

Cited by 70 publications

(65 citation statements)

References 27 publications

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“…Methods, study populations, length of follow-up, and mortality in the background population tend to differ across studies. A recent systematic review of excess mortality in type 1 diabetes diagnosed in childhood and adolescence found no relationship between a country's incidence of diabetes and SMRs [19]. The SMR in our cohort is very similar to that in a Finnish cohort of childhood-onset diabetes (SMR 3.6) [4].…”

Section: Discussionsupporting

confidence: 74%

“…However, studies differ in populations, diagnosis periods, duration of diabetes and age at diagnosis and this makes it difficult to directly compare studies with each other. Morgan et al showed that the excess mortality in type 1 diabetes diagnosed in childhood and adolescence was less marked in more recent studies and in countries with lower infant mortality and higher health expenditure, which suggests potential explanations for the differences [19].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported decreasing mortality rates in longterm follow-up of cohorts diagnosed during the 1960s and 1970s [5,8,[16][17][18]. A newly published systematic review assessing mortality in type 1 diabetes documented less marked excess mortality in more recent studies [19]. A recent Scottish study estimated a lower life expectancy compared with that of the general population [20].…”

Section: Introductionmentioning

confidence: 99%

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All-cause mortality in a nationwide cohort of childhood-onset diabetes in Norway 1973–2013

et al. 2015

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Aims/hypothesis The aim of this study was to assess the association between all-cause mortality and sex, age at diagnosis and year of diagnosis in Norwegian patients with childhoodonset diabetes. Methods The study was based on the nationwide, populationbased Norwegian Childhood Diabetes Registry, which includes all newly diagnosed cases of childhood-onset diabetes at age 0-14 years in 1973-1982 and 1989-2012 (n=7,884). Patients were followed until date of death, emigration or 30 September 2013. Results Among the 7,884 patients, representing 132,420 person-years, 249 (3.2%) died during a mean follow-up of 16.8 (range 0.0-40.7) years. The standardised mortality ratio (SMR) for the total cohort was 3.6 (95% CI 3.1, 4.0), increasing by attained age. Absolute mortality was significantly lower in females than in males (HR 0.50 [95% CI 0.38, 0.65]), although the SMRs were similar. Cox regression analysis showed a significant decrease in mortality of 49% (HR 0.51 [95% CI 0.28, 0.93]) for those diagnosed in 1999-2012 compared with those diagnosed in 1973-1982 (p=0.03). Conclusions/interpretation In spite of improved diabetes care, mortality is still three to four times higher in those with childhood-onset diabetes compared with the general population in Norway. However, absolute mortality has declined among children diagnosed most recently (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) compared with those diagnosed in the earliest period (1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982).

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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All-cause mortality in a nationwide cohort of childhood-onset diabetes in Norway 1973–2013

et al. 2015

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“…We found no relationship between mortality and socioeconomic status derived from postcode at diagnosis. In a systematic review including studies from many nations, there was no relationship between mortality and gross domestic product per head of population but a reduction in mortality with increased expenditure on healthcare 19. Higher mortality rates among individuals from lower socioeconomic background have been reported in Western Australia 9…”

Section: Discussionmentioning

confidence: 99%

Excess all-cause mortality before age 30 in childhood onset type 1 diabetes: data from the Brecon Group Cohort in Wales

et al. 2017

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“…Type 1 diabetes (T1DM) is consistently associated with increased mortality, though the excess risk may have recently decreased (1). Large differences in T1DM mortality are seen internationally, with in general a smaller excess mortality in Europe than in the U.S. (1).…”

Section: Introductionmentioning

confidence: 99%

A Contemporary Estimate of Total Mortality and Cardiovascular Disease Risk in Young Adults With Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study

et al. 2016

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OBJECTIVEThe degree to which mortality and cardiovascular disease (CVD) incidence remains elevated in young U.S. adults with type 1 diabetes (T1DM) is unclear. We determined contemporary rates for adults <45 years old with long-standing, childhood-onset T1DM from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.RESEARCH DESIGN AND METHODSMembers of the EDC Study cohort <45 years old during the 1996–2012 follow-up period (n = 502) were studied. Mortality and CVD rates were calculated for those aged 30–39 and 40–44 years. Data from the background Allegheny County, Pennsylvania, population were used to calculate age- and sex-matched standardized mortality (SMR) and incidence rate ratios (IRR).RESULTSIn both age groups, the SMR for total mortality was ∼5 (95% CIs: 30–39-year-olds, 2.8, 7.2; 40–44-year-olds, 3.4, 7.8). CVD mortality SMRs ranged from 19 (95% CI 11, 32) to 33 (95% CI 17, 59). Hospitalized CVD IRR was ∼8 (95% CIs: 30–39-year-olds, 2.5, 18.9; 40–44-year-olds, 4.5, 12.8); revascularization procedures account for much of the increased risk. For all outcomes, the relative risk was larger in women. Participants aged 30–39 years had 6.3% (95% CI 3.8, 9.8) absolute 10-year CVD risk, approaching the American College of Cardiology/American Heart Association–recommended cut point of 7.5% for initiation of statin therapy in older adults.CONCLUSIONSTotal and CVD mortality and hospitalized CVD are all significantly increased in this contemporary U.S. cohort of young adults with long-standing T1DM. These findings support more aggressive risk factor management in T1DM, especially among women.

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Excess mortality in Type 1 diabetes diagnosed in childhood and adolescence: a systematic review of population-based cohorts

Abstract: Excess mortality in childhood-/adolescent-diagnosed Type 1 diabetes is apparent across countries worldwide. Excesses were less marked in more recent studies and in countries with lower infant mortality and higher health expenditure.

Cited by 70 publications

References 27 publications

All-cause mortality in a nationwide cohort of childhood-onset diabetes in Norway 1973–2013

All-cause mortality in a nationwide cohort of childhood-onset diabetes in Norway 1973–2013

Excess all-cause mortality before age 30 in childhood onset type 1 diabetes: data from the Brecon Group Cohort in Wales

A Contemporary Estimate of Total Mortality and Cardiovascular Disease Risk in Young Adults With Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study

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