Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada

Laura C. Rosella · Kathy Kornas · Ednah Negatu · Limei Zhou

9 citations0/0 files storedBMJ Open Diabetes Research & Care

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Health disparities and outcomes Diabetes Management and Research Diabetes, Cardiovascular Risks, and Lipoproteins

Abstract

INTRODUCTION: Patients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in the population are lacking. This study aimed to examine the sociodemographic differences in the risk of all-cause mortality, premature mortality, and cause-specific mortality in persons diagnosed with diabetes. RESEARCH DESIGN AND METHODS: We conducted a population-based cohort study of 1 741 098 adults diagnosed with diabetes between 1994 and 2017 in Ontario, Canada using linked population files, Canadian census, health administrative and death registry databases. We analyzed the association between sociodemographics and other covariates on all-cause mortality and premature mortality using Cox proportional hazards models. A competing risk analysis using Fine-Gray subdistribution hazards models was used to analyze cardiovascular and circular mortality, cancer mortality, respiratory mortality, and mortality from external causes of injury and poisoning. RESULTS: After full adjustment, individuals with diabetes who lived in the lowest income neighborhoods had a 26% (HR 1.26, 95% CI 1.25 to 1.27) increased hazard of all-cause mortality and 44% (HR 1.44, 95% CI 1.42 to 1.46) increased risk of premature mortality, compared with individuals with diabetes living in the highest income neighborhoods. In fully adjusted models, immigrants with diabetes had reduced risk of all-cause mortality (HR 0.46, 95% CI 0.46 to 0.47) and premature mortality (HR 0.40, 95% CI 0.40 to 0.41), compared with long-term residents with diabetes. Similar HRs associated with income and immigrant status were observed for cause-specific mortality, except for cancer mortality, where we observed attenuation in the income gradient among persons with diabetes. CONCLUSIONS: The observed mortality variations suggest a need to address inequality gaps in diabetes care for persons with diabetes living in the lowest income areas.

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References

2000Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics 2000Type 2 diabetes mellitus in Canada's first nations: status of an epidemic in progress.2016Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada 2010Socioeconomic Status and Risk of Diabetes-Related Mortality in the U.S.2016Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario’s administrative health database 2011The healthy immigrant effect and mortality rates.2020Agreement between area- and individual-level income measures in a population-based cohort: Implications for population health research 2015Impact of diabetes on healthcare costs in a population‐based cohort: a cost analysis

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