Trends in mortality and hospitalisations for cardiovascular, kidney and liver disease in people with type 2 diabetes in England, 2009–2019
Naomi Holman, Bob Young, Edward W. Gregg, Nick Wareham, Stephen J. Sharp, Kamlesh Khunti, Naveed Sattar, Jonathan Valabhji
Abstract
AIMS: To assess longitudinal trends in total and cause-specific mortality rates and in hospitalisation rates for diabetes complications among people with type 2 diabetes in England between 2009 and 2019; and to assess how trends differ by patient characteristics. MATERIALS AND METHODS: A sequential cohort study of people with type 2 diabetes aged ≥20 years was performed using data from the National Diabetes Audit. Discretised Poisson regression models, adjusted for age, sex, ethnicity, socio-economic deprivation and diabetes duration, were used to calculate total and cause-specific mortality rates, as well as hospitalisation rates for myocardial infarction, stroke, heart failure, kidney and liver disease. RESULTS: Total mortality declined in people aged 20-74 years (rate ratio [RR] 0.96, 95% CI 0.95-0.97) and aged ≥75 years (0.93, 0.92-0.94) between 2009-2011 and 2018-2019, predominantly due to reductions in cardiovascular deaths. Over the same time period, in those aged 20-74 years, total mortality declined in people of South Asian (0.92:0.0.87-0.96) but was unchanged in people of White (1.00: 0.99-1.01) ethnicities. Total mortality declined more in people living in the least (0.91:0.88-0.94) compared to the most (0.97:0.95-1.00) deprived areas. A composite endpoint of cardiovascular hospitalisations and mortality increased between 2009-2011 and 2018-2019 in those aged 20-49 years (1.20:1.14-1.27) and 50-74 years (1.04:1.03-1.05) but declined in those aged ≥75 years (0.85:0.84-0.86). Rates of hospitalisation for kidney and liver disease increased in all age groups. CONCLUSIONS: By examining longitudinal trends in mortality and hospitalisations according to different characteristics in people with type 2 diabetes in England, we have identified important targets for improvement through changes in health policy and care delivery.