Diabetes Mortality Trends Were Stable in the Americas Over 20-Year Period

A new analysis showed stable trends in diabetes mortality in the Americas between 2000 and 2019, though it also revealed important differences in mortality based on sex and country.

The analysis, published in the International Journal of Epidemiology, included 33 countries in the Americas, which span North, South, and Central America. The study utilized data from the World Health Organization Global Health Estimates and the World Population Prospects, 2019 Revision, to estimate annual age-standardized mortality rates (ASMR) and assess disparities in diabetes and diabetic kidney disease (DKD) mortality by sex and country. Trend analyses were conducted using the annual average percentage of change (AAPC).

The Americas | Image credit: Віталій Баріда – stock.adobe.com

From 2000 to 2019, the overall mortality trend from diabetes in the Americas remained stable, with an AAPC of –0.2% (95% CI, –0.4 to 0.0). However, there were notable variations by sex and country. On the other hand, mortality from DKD increased by 1.5% (95% CI, 1.3%-1.6%) per year, with a faster rise observed in men than women, as well as variation across countries. Central America, Mexico, and the Latin Caribbean experienced significant increases in mortality for both diseases, particularly DKD. In contrast, North America—which the authors defined as Canada and the US—saw a decrease in diabetes mortality but an increase in DKD mortality.

In 2019 alone, diabetes—excluding DKD—was reported as the underlying cause of death for 284,049 deaths across the Americas, with the highest ASMR in Guyana (82.6 per 100,000) and the lowest in Canada (7.2 per 100,000). Over the 20-year period, diabetes accounted for more than 4.5 million deaths, with a slight regional decrease in ASMR from 21.9 per 100,000 in 2000 to 20.9 per 100,000 in 2019. Additionally, the trend analysis revealed a stable overall diabetes mortality trend, with a decline among women at –0.7% per year and an increase among men at 0.3% per year.

Notably, North America experienced the most significant decline in diabetes mortality, with AAPCs of –2.6% in women and –1.0% in men.

“According to the United States Renal Data System, the prevalence of DKD decreased from 41.5% in 2003-06 to 36.3% in 2015-18 among adults with diabetes, which contrasts with the rapid increase in DKD mortality evidenced in our study,” the authors said. “Previous studies with similar results argue that this increase could be mainly due to DKD from type 2 diabetes and improvements in DKD screening.”

Conversely, Central America, Mexico, and the Latin Caribbean exhibited increased diabetes mortality, particularly in men, with an AAPC of 1.0%. Within Central America, El Salvador, Nicaragua, and the Dominican Republic saw substantial increases in diabetes mortality among men, while Colombia experienced a notable decline.

Analysis of national diabetes excess mortality demonstrated considerable variation within and between countries by sex and over time. Male excess mortality in Central America, Mexico, and the Latin Caribbean increased from 1.87 times the regional rate in 2000 to 2.49 times in 2019. In contrast, the overall differences between subregional and regional rates decreased in the non-Latin Caribbean and North America by 2019 compared with 2000. North America showed the largest change in male excess mortality over the past 2 decades, with Canada and the US documenting an ASMR from diabetes in men almost twice the female rate in 2019. Other countries with similar dynamics included Argentina, Uruguay, Chile in the Southern Cone, Suriname, and Trinidad and Tobago in the non-Latin Caribbean.

Over the 20-year period analyzed, DKD accounted for more than 1.3 million deaths in the Americas, with 51.5% occurring in women. The ASMR for DKD increased from 5.4 to 7.7 per 100,000 population in men and from 4.9 to 6.0 per 100,000 population in women. In 2019, the highest ASMR for DKD was observed in Nicaragua for both men at 33.2 per 100,000 and women at 21.1 per 100,000, followed by Mexico at 21.1 per 100,000.

The regional DKD mortality exhibited an average annual increase of 1.5% from 2000 to 2019, with a faster rise in men compared with women, with AAPCs of 1.8% and 1.1%, respectively. Central America, Mexico, the Latin Caribbean, and North America experienced the largest increase. In contrast, the Southern Cone showed a slow decline in DKD mortality for both men and women.

Nationally, the trend analysis revealed substantial increments in DKD mortality, with notable increases in men—4.1% in Nicaragua—and women—3.8% in Guatemala. Interestingly, no country showed a decline in male mortality, emphasizing the persistence of rising trends. The analysis also highlighted persistent differences in ASMR from DKD between countries, with increasing male excess mortality observed in all subregions over time. In 2019, 10 of the 33 included countries documented a male-to-female mortality rate ratio of over 1.5.

According to the authors, the study revealed 3 crucial findings. First, while diabetes mortality rates have remained steady over the past 2 decades, the actual number of diabetes-related deaths is rising. Second, DKD mortality has increased in most countries, indicating challenges in diabetes control and insufficient preventive programs. Third, there are significant disparities in mortality levels across countries, emphasizing inequities in diabetes care throughout the region.

“The increase in DKD mortality is evidence of poorly controlled diabetes in the region,” the authors concluded. “The lack of programmes on prevention of complications, self-care management and gaps in quality health care may explain this trend and highlight the urgent need to build more robust health systems based on primary care, prioritizing diabetes prevention and control.”

Reference

Antini C, Caixeta R, Luciani S, Hennis AJM. Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019. Int J Epidemiol. Published online January 10, 2024. doi:10.1093/ije/dyad182