Diabetes and all-cause mortality among middle-aged and older adults in China, England, Mexico, rural South Africa, and the United States: A population-based study of longitudinal aging cohorts

ObjectiveThere is a need for comparable worldwide data on the impact of diabetes on mortality. This study assessed diabetes and all-cause mortality among middle-aged and older adults in five countries. Research Design and MethodsWe analyzed adults aged 51 years or older followed between 2010 and 2020 from population-based cohorts in China, England, Mexico, rural South Africa, and the United States. Diabetes was defined by self-report or an elevated diabetes blood-based biomarker meeting the clinical criteria for diabetes. All-cause mortality was assessed through linkages or informant interviews. We used Poisson regression models to estimate mortality rate ratios and mortality rate differences, comparing people with diabetes to those without diabetes. Models were adjusted for age, gender, education, smoking status, body mass index, and economic status. ResultsWe included 29,397 individuals, of whom 4,916 (16.7%) died during the study period. The median follow-up time ranged from 4.6 years in South Africa to 8.3 years in China. The adjusted all-cause mortality rate ratios for people with diabetes versus those without diabetes ranged from 1.53 (95% CI: 1.39-1.68) in the United States to 2.02 (95% CI: 1.34-3.06) in Mexico. The adjusted mortality rate differences (per 1,000 person-years) for people with diabetes versus those without diabetes ranged from 11.9 (95% CI: 4.8-18.9) in England to 24.6 (95% CI: 12.2-37.0) in South Africa. ConclusionsDiabetes was associated with increased all-cause mortality in population-based cohorts across five diverse countries. There is an urgent need to implement clinical and public health interventions to improve diabetes outcomes globally. ARTICLE HIGHLIGHTSO_ST_ABSWhy did we undertake this study?C_ST_ABSWe aimed to address the need for comparable estimates of all-cause mortality among people with diabetes in diverse global settings. What is the specific question(s) we wanted to answer?How does diabetes impact all-cause mortality among middle-aged and older adults (aged 51 years or greater) in China, England, Mexico, rural South Africa, and the United States? What did we find?Middle-aged and older adults with diabetes had higher all-cause mortality than people without diabetes in all countries. Relative mortality differences ranged from mortality rate ratios of 1.53 in the United States to 2.02 in Mexico. Absolute mortality differences ranged from mortality rate differences (per 1,000 person-years) of 11.9 in England to 24.6 in South Africa. What are the implications of our findings?There is an urgent need to implement clinical and public health interventions to improve diabetes outcomes globally.