Lancet Diabetes Endocrinol. 2022 Mar;10(3):177-192. doi: 10.1016/S2213-8587(21)00349-1. Epub 2022 Feb 7.
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.
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.
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 (r=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]).
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.
Bill & Melinda Gates Foundation.
在全球范围内，18 岁以下的青少年患糖尿病（包括 1 型和 2 型糖尿病），如果能够获得正确的医疗保健和服务，糖尿病是可以预防的。本研究旨在利用全球疾病、伤害和危险因素研究（GBD）2019 年的数据，评估全球 18 岁以下人群糖尿病死亡率及其变化趋势。
我们使用 GBD 2019 年的数据估算了 1990 年和 2019 年 18 岁以下人群的国际糖尿病死亡率。死因数据来源于 1990-2019 年的生命登记系统、口述尸检和其他监测系统。我们使用 GBD 死因综合模型估算每个地点的死亡率。我们分析了标准化死亡率与社会人口指数（SDI）和全民医保覆盖程度（UHC）的关联，并描述了 SDI 五分位数内的变化情况。我们报告了带有 95%置信区间的估计值。
2019 年，全球有 16300 例（95%置信区间 14200-18900 例）糖尿病（1 型和 2 型糖尿病）死亡发生在 18 岁以下人群中，其中 73.7%（68.3-77.4%）被归类为 1 型糖尿病。标准化死亡率为 0.50（0.44-0.58）/10 万人，其中 15900 例（97.5%）死亡发生在中低收入国家。高 SDI 五分位数的死亡率为 0.13（0.12-0.14）/10 万人，中低收入 SDI 五分位数的死亡率为 0.60（0.51-0.70）/10 万人，低收入 SDI 五分位数的死亡率为 0.71（0.60-0.86）/10 万人。在 SDI 五分位数内，我们观察到各国之间的死亡率存在很大差异，部分原因是全民医保覆盖程度的差异（r=0.62）。1990 年至 2019 年，所有糖尿病的标准化死亡率全球下降了 17.0%（-28.4 至-2.9），1 型糖尿病的标准化死亡率下降了 21.0%（-33.0 至-5.9）。然而，低 SDI 五分位数的所有糖尿病（-13.6%[-28.4 至 3.4]）和 1 型糖尿病（-13.6%[-29.3 至 8.9]）的下降幅度最小。
降低 18 岁以下人群的糖尿病死亡率仍然是一个重要挑战，尤其是在中低收入国家。糖尿病诊断和治疗不足可能是导致这些早逝的主要原因，这突出表明迫切需要提供更好的胰岛素获取途径和基本的糖尿病教育和护理。该死亡率指标源自易于获取且经常更新的 GBD 数据，可以帮助监测全球范围内可预防的糖尿病相关死亡情况，与联合国可持续发展目标保持一致，并作为各国 1 型和 2 型糖尿病基本护理充足性的指标。
比尔及梅琳达·盖茨基金会。
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