Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Ewerton Cousin, Bruce B Duncan, Caroline Stein, Kanyin Liane Ong, Theo Vos, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Michael Abdelmasseh, Amir Abdoli, Rami Abd-Rabu, Hassan Abolhassani, Eman Abu-Gharbieh, Manfred Mario Kokou Accrombessi, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Gina Agarwal, Krishna K Agrawaal, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Sajjad AhmadTauseef Ahmad, Keivan Ahmadi, Sepideh Ahmadi, Ali Ahmadi, Ali Ahmed, Yusra Ahmed Salih, Wuraola Akande-Sholabi, Tayyaba Akram, Hanadi Al Hamad, Ziyad Al-Aly, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Syed Mohamed Aljunid, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Robert Ancuceanu, Tudorel Andrei, Catalina Liliana Andrei, Ranjit Mohan Anjana, Adnan Ansar, Ippazio Cosimo Antonazzo, Benny Antony, Anayochukwu Edward Anyasodor, Jalal Arabloo, Damian Arizmendi, Benedetta Armocida, Anton A Artamonov, Judie Arulappan, Zahra Aryan, Samaneh Asgari, Tahira Ashraf, Thomas Astell-Burt, Prince Atorkey, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Ashish D Badiye, Atif Amin Baig, Mohan Bairwa, Jennifer L Baker, Ovidiu Constantin Baltatu, Palash Chandra Banik, Anthony Barnett, Mark Thomaz Ugliara Barone, Francesco Barone-Adesi, Amadou Barrow, Neeraj Bedi, Rebuma Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Derrick A Bennett, Isabela M Bensenor, David Beran, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Boris Bikbov, Setognal Birara, Virginia Bodolica, Aime Bonny, Hermann Brenner, Nikolay Ivanovich Briko, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Ismael R Campos-Nonato, Yin Cao, Chao Cao, Ester Cerin, Promit Ananyo Chakraborty, Joht Singh Chandan, Vijay Kumar Chattu, Simiao Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Barbara Corso, Omid Dadras, Xiaochen Dai, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Claudio Alberto Dávila-Cervantes, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Deepak Dhamnetiya, Daniel Diaz, Sanam Ebtehaj, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Islam Y Elgendy, Muhammed Elhadi, Mohamed A Elmonem, Mohammed Faisaluddin, Umar Farooque, Xiaoqi Feng, Eduarda Fernandes, Florian Fischer, David Flood, Marisa Freitas, Peter Andras Gaal, Mohamed M Gad, Piyada Gaewkhiew, Lemma Getacher, Mansour Ghafourifard, Reza Ghanei Gheshlagh, Ahmad Ghashghaee, Nermin Ghith, Ghozali Ghozali, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Sameer Vali Gopalani, Rafael Alves Guimarães, Rajat Das Gupta, Rajeev Gupta, Vivek Kumar Gupta, Veer Bala Gupta, Sapna Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Rabih Halwani, Asif Hanif, Graeme J Hankey, Shafiul Haque, Ahmed I Hasaballah, Syed Shahzad Hasan, Abdiwahab Hashi, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Mohammad Heidari, Mohammad Bellal Hossain Hossain, Sahadat Hossain, Mostafa Hosseini, Soodabeh Hoveidamanesh, Junjie Huang, Ayesha Humayun, Rabia Hussain, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Kevin S Ikuta, Leeberk Raja Inbaraj, Usman Iqbal, Md Shariful Islam, Sheikh Mohammed Shariful Islam, Rakibul M Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Ramaiah Itumalla, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Mohammad Ali Jahani, Mihajlo Jakovljevic, Ranil Jayawardena, Ravi Prakash Jha, Oommen John, Jost B Jonas, Tamas Joo, Ali Kabir, Rohollah Kalhor, Ashwin Kamath, Tanuj Kanchan, Himal Kandel, Neeti Kapoor, Gbenga A Kayode, Sewnet Adem Kebede, Pedram Keshavarz, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Moien AB Khan, Md Nuruzzaman Khan, Maseer Khan, Amir M Khater, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Vladimir Andreevich Korshunov, Oleksii Korzh, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Nithin Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Anders O Larsson, Savita Lasrado, Wei-Chen Lee, Chiachi Bonnie Lee, Paul H Lee, Shaun Wen Huey Lee, Ming-Chieh Li, Stephen S Lim, Lee-Ling Lim, Giancarlo Lucchetti, Azeem Majeed, Ahmad Azam Malik, Borhan Mansouri, Lorenzo Giovanni Mantovani, Santi Martini, Prashant Mathur, Colm McAlinden, Nafiul Mehedi, Teferi Mekonnen, Ritesh G Menezes, Amanual Getnet Mersha, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Andreea Mirica, Erkin M Mirrakhimov, Agha Zeeshan Mirza, Prasanna Mithra, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Ali Moni, Farhad Moradpour, Rahmatollah Moradzadeh, Ebrahim Mostafavi, Ulrich Otto Mueller, Christopher J L Murray, Ahmad Mustafa, Gabriele Nagel, Vinay Nangia, Atta Abbas Naqvi, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ruxandra Irina Negoi, Sandhya Neupane Kandel, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Jean Jacques Noubiap, Christoph Nowak, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, Temitope T Ojo, Andrew T Olagunju, Obinna E Onwujekwe, Alberto Ortiz, Mayowa O Owolabi, Raffaele Palladino, Songhomitra Panda-Jonas, Seithikurippu R Pandi-Perumal, Shahina Pardhan, Tarang Parekh, Mojtaba Parvizi, Veincent Christian Filipino Pepito, Arokiasamy Perianayagam, Ionela-Roxana Petcu, Manju Pilania, Vivek Podder, Roman V Polibin, Maarten J Postma, Akila Prashant, Navid Rabiee, Mohammad Rabiee, Vafa Rahimi-Movaghar, Muhammad Aziz Rahman, Md. Mosfequr Rahman, Mosiur Rahman, Setyaningrum Rahmawaty, Nazanin Rajai, Pradhum Ram, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Satish Rao, Salman Rawaf, David Laith Rawaf, Lal Rawal, Andre M N Renzaho, Nima Rezaei, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Peter Rohloff, Godfrey M Rwegerera, Paul MacDaragh Ryan, Maha Mohamed Saber-Ayad, Siamak Sabour, Basema Saddik, Sahar Saeedi Moghaddam, Amirhossein Sahebkar, Harihar Sahoo, KM Saif-Ur-Rahman, Hamideh Salimzadeh, Mehrnoosh Samaei, Juan Sanabria, Milena M Santric-Milicevic, Brijesh Sathian, Thirunavukkarasu Sathish, Markus P Schlaich, Abdul-Aziz Seidu, Mario Šekerija, Nachimuthu Senthil Kumar, Allen Seylani, Masood Ali Shaikh, Hina Shamshad, Md Shajedur Rahman Shawon, Sara Sheikhbahaei, Jeevan K Shetty, Rahman Shiri, K M Shivakumar, Kerem Shuval, Jasvinder A Singh, Ambrish Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ahmad Sofi-Mahmudi, Amin Soheili, Jing Sun, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Hooman Tadbiri, Eyayou Girma Tadesse, Md. Tariqujjaman, Kavumpurathu Raman Thankappan, Rekha Thapar, Nihal Thomas, Binod Timalsina, Ruoyan Tobe-Gai, Marcello Tonelli, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Jaya Prasad Tripathy, Lorainne Tudor Car, Biruk Shalmeno Tusa, Riaz Uddin, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari, Madhur Verma, Victor E Villalobos-Daniel, Sergey Konstantinovitch Vladimirov, Bay Vo, Giang Thu Vu, Rade Vukovic, Yasir Waheed, Richard G Wamai, Andrea Werdecker, Nuwan Darshana Wickramasinghe, Andrea Sylvia Winkler, Befikadu Legesse Wubishet, Xiaoyue Xu, Suowen Xu, Seyed Hossein Yahyazadeh Jabbari, Hiroshi Yatsuya, Sanni Yaya, Taklo Simeneh Yazie Yazie, Siyan Yi, Naohiro Yonemoto, Ismaeel Yunusa, Siddhesh Zadey, Sojib Bin Zaman, Maryam Zamanian, Nelson Zamora, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Alimuddin Zumla, Mohsen Naghavi, Maria Inês Schmidt

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Abstract

Summary Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding Bill & Melinda Gates Foundation.
Original languageEnglish
Pages (from-to)177-192
Number of pages16
JournalThe Lancet Diabetes and Endocrinology
Volume10
Issue number3
DOIs
Publication statusPublished - 2022

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