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Abstract
Objective To estimate age-specific and sex-specific all-cause mortality among adults with and without type 2 diabetes (T2D) in Germany.
Research design and methods The German National Health Interview and Examination Survey 1998 (GNHIES98) included a mortality follow-up (median follow-up time 12.0 years) of its nationwide sample representative of the population aged 18–79 years. After exclusion of participants with type 1 diabetes, age- and sex-stratified mortality rates (MR) were calculated for 330 GNHIES98 participants with diagnosed T2D (self-reported diagnosis or antidiabetic medication), 245 with undiagnosed T2D (no diagnosed T2D, glycated hemoglobin A1c ≥6.5% (≥48 mmol/mol)), and 5975 without T2D. Mortality rate ratios (MRR) comparing MR of persons with and without T2D were estimated. Age-/sex-standardized MR and MRR were calculated including persons aged 45 years or older. MRR were used to estimate the number of years of life lost (YLL) due to diagnosed diabetes in 2010.
Results Over 75 994 person-years, 73 persons with undiagnosed T2D, 103 with diagnosed T2D, and 425 persons without T2D died. MRR were significantly higher in younger age groups, except for analyses limited to women or diagnosed T2D. Age- and sex-standardized MRR (95% CI) among persons aged 45 years or older were 1.96 (1.41 to 2.71) for undiagnosed, 1.68 (1.26 to 2.23) for diagnosed, and 1.82 (1.45 to 2.28) for total (undiagnosed or diagnosed) T2D. Sex-stratified analysis revealed similar age-standardized MRR for undiagnosed (1.56 (0.79 to 3.06)) and diagnosed T2D (1.56 (1.03 to 2.37)) among women, and a higher age-standardized MRR for undiagnosed (2.06 (1.43 to 2.97)) than diagnosed T2D (1.70 (1.10 to 2.63)) among men. YLL due to diagnosed diabetes in Germany in 2010 were 164 600 (35 000 to 279 300) among women and 169 900 (28 300 to 328 300) among men.
Conclusions In Germany, age- and sex-standardized all-cause mortality is almost twice as high for adults with T2D as for adults without T2D. The T2D-associated excess risk of mortality appears to be most pronounced in younger adults and among men unaware of their T2D.
- mortality
- type 2 diabetes
- public health/surveillance
- national health surveys
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Footnotes
Contributors SR helped conceptualize the study, calculated mortality rates and rate ratios, conducted standardization of published mortality rates from international studies to the German population 1998 for comparison with results of the present study, and drafted figures, tables, text, and supplementary material of the manuscript. RB helped conceptualize the study, supported the calculation of mortality rates and rate ratios, calculated years of life lost, reviewed and edited the manuscript, and contributed to the discussion. JB supported the calculation of mortality rates and rate ratios, as well as standardization of published mortality rates to the German population 1998, reviewed and edited the manuscript, and contributed to the discussion. CH helped conceptualize the study, reviewed and edited the manuscript, and contributed to the discussion. RP supported descriptive data analysis, reviewed and edited the manuscript, and contributed to the discussion. YD contributed the calculation of diabetes prevalence to the estimation of years of life lost, reviewed and edited the manuscript, and contributed to the discussion. CSN conceptualized and supervised the study and substantially contributed to the writing of the manuscript. CSN is the guarantor who takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript. All authors read and approved the final version of the manuscript.
Funding This work was supported by a research grant from the Federal Ministry of Health Germany (grant number: GE 2015 03 23). The conduction of national health surveys in Germany is funded by the Federal Ministry of Health as part of the continuous national health monitoring.
Competing interests CSN reports grants from the Federal Ministry of Health, Germany, grant number GE 2015 03 23, during the conduct of the study.
Ethics approval Federal Commissioner for the Protection of Data and Freedom of Information.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The authors confirm that some access restrictions apply to the data underlying the findings. The data set cannot be made publicly available because informed consent from study participants did not cover public deposition of data. However, the minimal data set underlying the findings is archived in the ’Health Monitoring' Research Data Centre at the Robert Koch Institute (RKI) and can be accessed by all interested researchers. On-site access to the data set is possible at the Secure Data Center of the RKI’s ’Health Monitoring' Research Data Centre. Requests should be submitted to the ’Health Monitoring' Research Data Centre, Robert Koch Institute, Berlin, Germany (e-mail: fdz@rki.de).