327-OR: Multicountry Analysis of Trends in All-Cause Mortality among People with Type 1 Diabetes
Authors: RUIZ PAZ LOPEZ-DORIGA , CHEN LEI , MORTON JEDIDIAH I. , SALIM AGUS , CARSTENSEN BENDIX , GREGG EDWARD W. , PAVKOV MEDA E. , MATA-CASES MANEL , MAURICIO DIDAC , NICHOLS GREGORY A. , PILDAVA SANTA , READ STEPHANIE H. , WILD SARAH , SHAW JONATHAN E. , MAGLIANO DIANNA J. 
Published: June 2021

Some studies have suggested a declining mortality in type 1 diabetes, but it is unclear if the pattern of mortality trends differs by country and age group, and how mortality trends in type 1 diabetes relate to trends in the general population mortality. We assembled aggregated data on all-cause mortality in people with type 1 diabetes by 5-year age group and sex between 2000 and 2016 from an international diabetes consortium database, GLOBODIAB. Data were from administrative sources, health insurance records and registries. We used joinpoint regression analysis to examine trends in annual mortality rates (standardized to the 2010 European Union population) and mortality rate ratios (MRRs) (relative to the mortality in people without diabetes) in all age groups, and stratified by age (&lt;40, 40-59, and 60-84 years). Among the six data sources from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and US (Kaiser Permanente northwest; KPNW), a total of 20,351 deaths occurred during 1.6 million person-years of follow-up in people with type 1 diabetes aged 0-84 years. Age- and sex-standardized mortality rates in people with type 1 diabetes decreased in five data sources, with stable mortality rates over time in Catalonia. Declining mortality was observed in people aged 60-84 years for all six data sources, but in people aged 40-59 years, declines were observed only for Denmark, Latvia, and KPNW. Stable mortality was observed in people &lt;40 years in all six data sources. Mortality was 3-4 times higher in people with type 1 diabetes relative to those without diabetes with statistically significantly higher MRRs in all three age groups.
In conclusion, all-cause mortality in type 1 diabetes has declined in recent years in the majority of data sources, but remains considerably higher than in the nondiabetic population. These data highlight that there is still scope to improve mortality in type 1 diabetes and reduce inequalities within and between populations.

Disclosure
P. Lopez-doriga ruiz: None. G. A. Nichols: Research Support; Self; Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, National Institute of Diabetes and Digestive and Kidney Diseases. S. Pildava: None. S. H. Read: Employee; Self; Certara. S. Wild: Advisory Panel; Self; Gilead Sciences, Inc., Other Relationship; Self; Novo Nordisk. J. E. Shaw: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Pfizer Inc., Research Support; Self; AstraZeneca, Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk. D. J. Magliano: None. L. Chen: None. J. I. Morton: None. A. Salim: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk. E. W. Gregg: None. M. E. Pavkov: None. M. Mata-cases: Consultant; Self; Mundipharma International, Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., MSD Corporation, Novo Nordisk. D. Mauricio: None.

Funding
Centers for Disease Control and Prevention