Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Dunya Tomic; Jedidiah I. Morton; Lei Chen; Agus Salim; Edward W. Gregg; Meda E. Pavkov; Martti Arffman; Ran Balicer; Marta Baviera; Elise Boersma-van Dam; Ralph Brinks; Bendix Carstensen; Juliana C.N. Chan; Yiling J. Cheng; Sandrine Fosse-Edorh; Sonsoles Fuentes; Hélène Gardiner; Hanne L. Gulseth; Romualdas Gurevicius; Kyoung Hwa Ha; Annika Hoyer; György Jermendy; Alexandra Kautzky-Willer; Ilmo Keskimäki; Dae Jung Kim; Zoltán Kiss; Peter Klimek; Maya Leventer-Roberts; Chun Yi Lin; Paz Lopez-Doriga Ruiz; Andrea O.Y. Luk; Stefan Ma; Manel Mata-Cases; Dídac Mauricio; Stuart McGurnaghan; Tomoaki Imamura; Sanjoy K. Paul; Anna Peeters; Santa Pildava; Avi Porath; Cynthia Robitaille; Maria Carla Roncaglioni; Takehiro Sugiyama; Kang Ling Wang; Sarah H. Wild; Naama Yekutiel; Jonathan E. Shaw; Dianna J. Magliano

doi:10.1016/S2213-8587(22)00252-2

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Dunya Tomic, Jedidiah I. Morton, Lei Chen, Agus Salim, Edward W. Gregg, Meda E. Pavkov, Martti Arffman, Ran Balicer, Marta Baviera, Elise Boersma-van Dam, Ralph Brinks, Bendix Carstensen, Juliana C.N. Chan, Yiling J. Cheng, Sandrine Fosse-Edorh, Sonsoles Fuentes, Hélène Gardiner, Hanne L. Gulseth, Romualdas Gurevicius, Kyoung Hwa HaAnnika Hoyer, György Jermendy, Alexandra Kautzky-Willer, Ilmo Keskimäki, Dae Jung Kim, Zoltán Kiss, Peter Klimek, Maya Leventer-Roberts, Chun Yi Lin, Paz Lopez-Doriga Ruiz, Andrea O.Y. Luk, Stefan Ma, Manel Mata-Cases, Dídac Mauricio, Stuart McGurnaghan, Tomoaki Imamura, Sanjoy K. Paul, Anna Peeters, Santa Pildava, Avi Porath, Cynthia Robitaille, Maria Carla Roncaglioni, Takehiro Sugiyama, Kang Ling Wang, Sarah H. Wild, Naama Yekutiel, Jonathan E. Shaw, Dianna J. Magliano

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

31 Citations (Scopus)

Abstract

Background: Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods: For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20–100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005–19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Findings: Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6–17·0) for Scottish women to 59·6% (58·5–60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017–18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2–59·3) for men and 64·1 years (64·0–64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013–14 in Lithuania (43·7 years [42·7–44·6]) for men and in 2010–11 in Latvia (54·2 years [53·4–54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010–11 to 2015–16 and in the USA from 2009–10 to 2014–15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015–16) to 12·9 years (Israel Clalit Health Services; 2015–16) for 20-year-old men and from 3·1 years (Finland; 2011–12) to 11·2 years (Israel Clalit Health Services; 2010–11 and 2015–16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009–10 and 2014–15 for 20-year-old men (a decrease of 2·7 years). Interpretation: Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. Funding: US Centers for Disease Control and Prevention and Diabetes Australia.

Original language	English
Pages (from-to)	795-803
Number of pages	9
Journal	The Lancet Diabetes and Endocrinology
Volume	10
Issue number	11
DOIs	https://doi.org/10.1016/S2213-8587(22)00252-2
Publication status	Published - Nov 2022
Publication type	A1 Journal article-refereed

Funding

This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support.

Publication forum classification

Publication forum level 3

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/S2213-8587(22)00252-2

Cite this

Tomic, D., Morton, J. I., Chen, L., Salim, A., Gregg, E. W., Pavkov, M. E., Arffman, M., Balicer, R., Baviera, M., Boersma-van Dam, E., Brinks, R., Carstensen, B., Chan, J. C. N., Cheng, Y. J., Fosse-Edorh, S., Fuentes, S., Gardiner, H., Gulseth, H. L., Gurevicius, R., ... Magliano, D. J. (2022). Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. The Lancet Diabetes and Endocrinology, 10(11), 795-803. https://doi.org/10.1016/S2213-8587(22)00252-2

@article{f04526973b2346119993abea6594ae22,

title = "Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study",

abstract = "Background: Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods: For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20–100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005–19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Findings: Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6–17·0) for Scottish women to 59·6% (58·5–60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017–18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2–59·3) for men and 64·1 years (64·0–64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013–14 in Lithuania (43·7 years [42·7–44·6]) for men and in 2010–11 in Latvia (54·2 years [53·4–54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010–11 to 2015–16 and in the USA from 2009–10 to 2014–15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015–16) to 12·9 years (Israel Clalit Health Services; 2015–16) for 20-year-old men and from 3·1 years (Finland; 2011–12) to 11·2 years (Israel Clalit Health Services; 2010–11 and 2015–16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009–10 and 2014–15 for 20-year-old men (a decrease of 2·7 years). Interpretation: Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. Funding: US Centers for Disease Control and Prevention and Diabetes Australia.",

author = "Dunya Tomic and Morton, {Jedidiah I.} and Lei Chen and Agus Salim and Gregg, {Edward W.} and Pavkov, {Meda E.} and Martti Arffman and Ran Balicer and Marta Baviera and {Boersma-van Dam}, Elise and Ralph Brinks and Bendix Carstensen and Chan, {Juliana C.N.} and Cheng, {Yiling J.} and Sandrine Fosse-Edorh and Sonsoles Fuentes and H{\'e}l{\`e}ne Gardiner and Gulseth, {Hanne L.} and Romualdas Gurevicius and Ha, {Kyoung Hwa} and Annika Hoyer and Gy{\"o}rgy Jermendy and Alexandra Kautzky-Willer and Ilmo Keskim{\"a}ki and Kim, {Dae Jung} and Zolt{\'a}n Kiss and Peter Klimek and Maya Leventer-Roberts and Lin, {Chun Yi} and {Lopez-Doriga Ruiz}, Paz and Luk, {Andrea O.Y.} and Stefan Ma and Manel Mata-Cases and D{\'i}dac Mauricio and Stuart McGurnaghan and Tomoaki Imamura and Paul, {Sanjoy K.} and Anna Peeters and Santa Pildava and Avi Porath and Cynthia Robitaille and Roncaglioni, {Maria Carla} and Takehiro Sugiyama and Wang, {Kang Ling} and Wild, {Sarah H.} and Naama Yekutiel and Shaw, {Jonathan E.} and Magliano, {Dianna J.}",

note = "Funding Information: This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support. Publisher Copyright: {\textcopyright} 2022 Elsevier Ltd",

year = "2022",

month = nov,

doi = "10.1016/S2213-8587(22)00252-2",

language = "English",

volume = "10",

pages = "795--803",

journal = "The Lancet Diabetes and Endocrinology",

issn = "2213-8587",

publisher = "Elsevier",

number = "11",

}

Tomic, D, Morton, JI, Chen, L, Salim, A, Gregg, EW, Pavkov, ME, Arffman, M, Balicer, R, Baviera, M, Boersma-van Dam, E, Brinks, R, Carstensen, B, Chan, JCN, Cheng, YJ, Fosse-Edorh, S, Fuentes, S, Gardiner, H, Gulseth, HL, Gurevicius, R, Ha, KH, Hoyer, A, Jermendy, G, Kautzky-Willer, A, Keskimäki, I, Kim, DJ, Kiss, Z, Klimek, P, Leventer-Roberts, M, Lin, CY, Lopez-Doriga Ruiz, P, Luk, AOY, Ma, S, Mata-Cases, M, Mauricio, D, McGurnaghan, S, Imamura, T, Paul, SK, Peeters, A, Pildava, S, Porath, A, Robitaille, C, Roncaglioni, MC, Sugiyama, T, Wang, KL, Wild, SH, Yekutiel, N, Shaw, JE & Magliano, DJ 2022, 'Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study', The Lancet Diabetes and Endocrinology, vol. 10, no. 11, pp. 795-803. https://doi.org/10.1016/S2213-8587(22)00252-2

TY - JOUR

T1 - Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions

T2 - a multinational, population-based study

AU - Tomic, Dunya

AU - Morton, Jedidiah I.

AU - Chen, Lei

AU - Salim, Agus

AU - Gregg, Edward W.

AU - Pavkov, Meda E.

AU - Arffman, Martti

AU - Balicer, Ran

AU - Baviera, Marta

AU - Boersma-van Dam, Elise

AU - Brinks, Ralph

AU - Carstensen, Bendix

AU - Chan, Juliana C.N.

AU - Cheng, Yiling J.

AU - Fosse-Edorh, Sandrine

AU - Fuentes, Sonsoles

AU - Gardiner, Hélène

AU - Gulseth, Hanne L.

AU - Gurevicius, Romualdas

AU - Ha, Kyoung Hwa

AU - Hoyer, Annika

AU - Jermendy, György

AU - Kautzky-Willer, Alexandra

AU - Keskimäki, Ilmo

AU - Kim, Dae Jung

AU - Kiss, Zoltán

AU - Klimek, Peter

AU - Leventer-Roberts, Maya

AU - Lin, Chun Yi

AU - Lopez-Doriga Ruiz, Paz

AU - Luk, Andrea O.Y.

AU - Ma, Stefan

AU - Mata-Cases, Manel

AU - Mauricio, Dídac

AU - McGurnaghan, Stuart

AU - Imamura, Tomoaki

AU - Paul, Sanjoy K.

AU - Peeters, Anna

AU - Pildava, Santa

AU - Porath, Avi

AU - Robitaille, Cynthia

AU - Roncaglioni, Maria Carla

AU - Sugiyama, Takehiro

AU - Wang, Kang Ling

AU - Wild, Sarah H.

AU - Yekutiel, Naama

AU - Shaw, Jonathan E.

AU - Magliano, Dianna J.

N1 - Funding Information: This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: This study was funded by the US Centers for Disease Control and Prevention and Diabetes Australia. DT and JIM are supported by an Australian Government Research Training Program Scholarship and a Monash Graduate Excellence Scholarship. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. This work was supported by labour research grants from the Ministry of Health, Labour and Welfare of Japan (22FA1018, 20FA1016, and 19FA1002). This study used Korean National Health Insurance Service (NHIS)-National Sample Cohort data (NHIS-2022-2-125) from the NHIS. The authors declare no conflict of interest with the NHIS. The findings and conclusions in this Article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. We thank Toshimasa Yamauchi (The University of Tokyo, Tokyo, Japan) and Yuichi Nishioka (Nara Medical University, Nara, Japan) for their comments and analytical support. Publisher Copyright: © 2022 Elsevier Ltd

PY - 2022/11

Y1 - 2022/11

N2 - Background: Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods: For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20–100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005–19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Findings: Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6–17·0) for Scottish women to 59·6% (58·5–60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017–18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2–59·3) for men and 64·1 years (64·0–64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013–14 in Lithuania (43·7 years [42·7–44·6]) for men and in 2010–11 in Latvia (54·2 years [53·4–54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010–11 to 2015–16 and in the USA from 2009–10 to 2014–15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015–16) to 12·9 years (Israel Clalit Health Services; 2015–16) for 20-year-old men and from 3·1 years (Finland; 2011–12) to 11·2 years (Israel Clalit Health Services; 2010–11 and 2015–16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009–10 and 2014–15 for 20-year-old men (a decrease of 2·7 years). Interpretation: Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. Funding: US Centers for Disease Control and Prevention and Diabetes Australia.

AB - Background: Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods: For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20–100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005–19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Findings: Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6–17·0) for Scottish women to 59·6% (58·5–60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017–18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2–59·3) for men and 64·1 years (64·0–64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013–14 in Lithuania (43·7 years [42·7–44·6]) for men and in 2010–11 in Latvia (54·2 years [53·4–54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010–11 to 2015–16 and in the USA from 2009–10 to 2014–15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015–16) to 12·9 years (Israel Clalit Health Services; 2015–16) for 20-year-old men and from 3·1 years (Finland; 2011–12) to 11·2 years (Israel Clalit Health Services; 2010–11 and 2015–16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009–10 and 2014–15 for 20-year-old men (a decrease of 2·7 years). Interpretation: Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. Funding: US Centers for Disease Control and Prevention and Diabetes Australia.

U2 - 10.1016/S2213-8587(22)00252-2

DO - 10.1016/S2213-8587(22)00252-2

M3 - Article

C2 - 36183736

AN - SCOPUS:85140211673

SN - 2213-8587

VL - 10

SP - 795

EP - 803

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

IS - 11

ER -

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Abstract

Funding

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ASJC Scopus subject areas

UN SDGs

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