Diabetes, prediabetes linked to shorter life expectancy in China
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Key takeaways:
- During mean follow-up of 6 years, nearly 42% of patients who died had prediabetes, researchers found.
- At age 40 years, participants with diabetes died 4.2 years earlier than control participants.
Diabetes and prediabetes were significantly associated with decreased life expectancy and increased risk for all-cause, cardiovascular disease and cancer mortality among Chinese adults, according to findings published in Diabetes Care.
At the end of 2021, more than 140 million Chinese adults were diagnosed with diabetes and approximately 38% of Chinese adults qualified for prediabetes in 2018, according to the researchers. The link between diabetes and prediabetes and increased risk for mortality and diseases such as CVD and cancer is well established.
“However, because national data are lacking, the actual contribution of these two diseases to mortality and life-years lost in China remains unknown,” Yunli Tian, of the department of cardiovascular diseases and the Clinical Center for Human Genomic Research at Union Hospital and Tongji Medical College at the Huazhong University of Science and Technology in Wuhan, China, and colleagues wrote.
The researchers performed a national longitudinal cohort study to examine the effect of diabetes and prediabetes on life expectancy and mortality among Chinese adults, as well as the role sociodemographic factors play in affecting that risk.
The analysis included 135,405 participants aged 18 years and older who were enrolled in the China Chronic Disease and Risk Factors Surveillance study. Of them, 10.5% (mean age, 57.9 years; 55.7% women) had diabetes and 36.2% (mean age, 53.9 years; 56.8% women) had prediabetes in 2013. Participants with diabetes and prediabetes were older and more likely to be men and physically inactive.
During a median follow-up of 6 years, the researchers found that 5,517 participants died, of whom 2,300 (41.7%) had prediabetes and 1,428 (25.9%) had diabetes. Regardless of diabetes status, CVD and cancer were the first and second leading causes of death, and diabetes was the third leading cause of death among people with the disease. Notably, CVD accounted for 44.7% of deaths among people with diabetes from 2013 to 2019.
Next, researchers used Cox regression analysis models to calculate adjusted mortality rate ratios (RRs). They found that diabetes and prediabetes were associated with increased risk for all-cause mortality (diabetes: RR = 1.61; 95% CI, 1.49-1.73; prediabetes: RR = 1.08; 95% CI, 1.01-1.15) compared with participants without diabetes.
This all-cause mortality risk appeared greater for participants with diabetes living in rural areas (RR = 1.71; 95% CI, 1.55-1.89) compared with urban areas (RR = 1.5; 95% CI, 1.35-1.68), as well as for those younger than 65 years (RR = 1.75; 95% CI, 1.56-1.96) vs. aged 65 years and older (RR = 1.5; 95% CI, 1.36-1.65).
Regarding life expectancy, the researchers found that compared with normoglycemic participants, participants at age 40 years with diabetes and prediabetes typically died sooner. Specifically, women and men with diabetes died approximately 4.2 years earlier, whereas those with prediabetes died 0.7 years earlier.
Researchers also found that CVD was the leading cause of reduced life expectancy among patients with abnormal blood glucose levels, who were at increased risk for CVD mortality compared with control participants (diabetes: RR = 1.59; 95% CI, 1.41-1.78; prediabetes: RR = 1.1; 95% CI, 1-1.21).
Also, the researchers found that diabetes was associated with a 31% (RR = 1.31; 95% CI, 1.14, 1.49) greater risk for total cancer mortality regardless of age and sex, although prediabetes did not show a similar risk. Further, diabetes was significantly associated with increased risk for death of liver disease, respiratory disease, diabetic ketoacidosis or coma.
Tian and colleagues noted several limitations to this study, including the unavailability of detailed death data and relatively few cancer-related deaths.
“More research is needed ... to develop targeted interventions to reduce the burden of diabetes and its complications in China,” the researchers wrote.
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