Diabetes Metab J.  2018 Oct;42(5):394-401. 10.4093/dmj.2017.0088.

Ten-Year Mortality Trends for Adults with and without Diabetes Mellitus in South Korea, 2003 to 2013

• Kim KJ
• Kwon TY
• Yu S
• Seo JA
• Kim NH
• Choi KM
• Baik SH
• Choi DS
• Kim SG
• Park Y
• Kim NH

• KMID: 2422784
• DOI: http://doi.org/10.4093/dmj.2017.0088

Abstract

BACKGROUND
To estimate and compare the trends of all-cause and cause-specific mortality rates for subjects with and without diabetes in South Korea, from 2003 to 2013.
METHODS
Using a population-based cohort (2003 to 2013), we evaluated annual mortality rates in adults (≥30 years) with and without diabetes. The number of subjects in this analysis ranged from 585,795 in 2003 to 670,020 in 2013.
RESULTS
Age- and sex-adjusted all-cause mortality rates decreased consistently in both groups from 2003 to 2013 (from 14.4 to 9.3/1,000 persons in subjects with diabetes and from 7.9 to 4.4/1,000 persons in those without diabetes). The difference in mortality rates between groups also decreased (6.61 per 1,000 persons in 2003 to 4.98 per 1,000 persons in 2013). The slope associated with the mortality rate exhibited a steeper decrease in subjects with diabetes than those without diabetes (regression coefficients of time: −0.50 and −0.33, respectively; P=0.004). In subjects with diabetes, the mortality rate from cardiovascular disease decreased by 53.5% (from 2.73 to 1.27 per 1,000 persons, P for trend < 0.001). Notably, the decrease in mortality from ischemic stroke (79.2%, from 1.20 to 0.25 per 1,000 persowns) was more profound than that from ischemic heart disease (28.3%, from 0.60 to 0.43 per 1,000 persons).
CONCLUSION
All-cause and cardiovascular mortality rates decreased substantially from 2003 to 2013, and the decline in ischemic stroke mortality mainly contributed to the decreased cardiovascular mortality in Korean people with diabetes.

Keyword

Cardiovascular diseases; Diabetes mellitus; Mortality

MeSH Terms

Adult*
Cardiovascular Diseases
Cohort Studies
Diabetes Mellitus*
Humans
Korea*
Mortality*
Myocardial Ischemia
Stroke

Figure

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  Fig. 1 Annual trends of the standardized all-cause mortality rates for subjects with diabetes (black bar) and without diabetes (white bar) from 2003 to 2013. DM, diabetes mellitus.

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  Fig. 2 Annual trends in the standardized mortality rates from cardiovascular disease (CVD), ischemic stroke, and ischemic heart disease for subjects with diabetes (A) and without diabetes (B).

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  Fig. 3 Trends in mortality rates and annualized slopes for mortality from (A) any cause, (B) all cardiovascular diseases, (C) ischemic stroke, and (D) ischemic heart disease for subjects with and without diabetes. DM, diabetes mellitus.

Reference

1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M. Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet. 2011; 378:31–40. PMID: 21705069.

2. Gregg EW, Cheng YJ, Saydah S, Cowie C, Garfield S, Geiss L, Barker L. Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care. 2012; 35:1252–1257. PMID: 22619288.

3. Lind M, Garcia-Rodriguez LA, Booth GL, Cea-Soriano L, Shah BR, Ekeroth G, Lipscombe LL. Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study. Diabetologia. 2013; 56:2601–2608. PMID: 24114114.

4. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999; 281:1291–1297. PMID: 10208144.

5. Preis SR, Pencina MJ, Hwang SJ, D'Agostino RB Sr, Savage PJ, Levy D, Fox CS. Trends in cardiovascular disease risk factors in individuals with and without diabetes mellitus in the Framingham Heart Study. Circulation. 2009; 120:212–220. PMID: 19581493.

6. Harding JL, Shaw JE, Peeters A, Guiver T, Davidson S, Magliano DJ. Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010. Diabetes Care. 2014; 37:2579–2586. PMID: 24947787.

7. Lipscombe LL, Hux JE. Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet. 2007; 369:750–756. PMID: 17336651.

8. Barquera S, Tovar-Guzman V, Campos-Nonato I, Gonzalez-Villalpando C, Rivera-Dommarco J. Geography of diabetes mellitus mortality in Mexico: an epidemiologic transition analysis. Arch Med Res. 2003; 34:407–414. PMID: 14602508.

9. Choi YJ, Cho YM, Park CK, Jang HC, Park KS, Kim SY, Lee HK. Rapidly increasing diabetes-related mortality with socioenvironmental changes in South Korea during the last two decades. Diabetes Res Clin Pract. 2006; 74:295–300. PMID: 16707191.

10. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J. China National Diabetes and Metabolic Disorders Study Group. Prevalence of diabetes among men and women in China. N Engl J Med. 2010; 362:1090–1101. PMID: 20335585.

11. World Health Organization. Global health estimates: deaths by cause, age, sex and country, 2000–2012. Geneva: World Health Organization;2014.

12. Song SO, Lee YH, Kim DW, Song YD, Nam JY, Park KH, Kim DJ, Park SW, Lee HC, Lee BW. Trends in diabetes incidence in the last decade based on Korean National Health Insurance claims data. Endocrinol Metab (Seoul). 2016; 31:292–299. PMID: 27302715.

13. Choi YJ, Kim HC, Kim HM, Park SW, Kim J, Kim DJ. Prevalence and management of diabetes in Korean adults: Korea National Health and Nutrition Examination Surveys 1998–2005. Diabetes Care. 2009; 32:2016–2020. PMID: 19675201.

14. Korea Diabetes Association. Diabetes fact sheet in Korea 2013. cited 2018 Mar 30. Available from: http://www.diabetes.or.kr/temp/diabetes_factsheet_2013111.pdf.

15. Kim NH, Lee J, Kim TJ, Kim NH, Choi KM, Baik SH, Choi DS, Pop-Busui R, Park Y, Kim SG. Body mass index and mortality in the general population and in subjects with chronic disease in Korea: a nationwide cohort study (2002–2010). PLoS One. 2015; 10:e0139924. PMID: 26462235.

16. Indrayan A. Medical Biostatistics. 3rd ed. Boca Raton: CRC Press;2012.

17. Altman D, Machin D, Bryant T, Gardner M. Statistics with confidence: confidence intervals and statistical guidelines. Hoboken: John Wiley & Sons;2013.

18. Gregg EW, Albright AL. The public health response to diabetes: two steps forward, one step back. JAMA. 2009; 301:1596–1598. PMID: 19366782.

19. Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, Williams DE, Geiss L. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014; 370:1514–1523. PMID: 24738668.

20. Gregg EW, Gu Q, Cheng YJ, Narayan KM, Cowie CC. Mortality trends in men and women with diabetes, 1971 to 2000. Ann Intern Med. 2007; 147:149–155. PMID: 17576993.

21. Jeon JY, Kim DJ, Ko SH, Kwon HS, Lim S, Choi SH, Kim CS, An JH, Kim NH, Won JC, Kim JH, Cha BY, Song KH. Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association. Current status of glycemic control of patients with diabetes in Korea: the Fifth Korea National Health and Nutrition Examination Survey. Diabetes Metab J. 2014; 38:197–203. PMID: 25003073.

22. Ha KH, Kim DJ. Current status of managing diabetes mellitus in Korea. Korean J Intern Med. 2016; 31:845–850. PMID: 27604796.

23. Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC. Guideline Committee of the Korean Society of Hypertension. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2015; 21:3. PMID: 26893917.

24. Ha KH, Kwon HS, Kim DJ. Epidemiologic characteristics of dyslipidemia in Korea. J Lipid Atheroscler. 2015; 4:93–99.

25. Jung KH, Lee SH, Kim BJ, Yu KH, Hong KS, Lee BC, Roh JK. Korean Stroke Registry Study Group. Secular trends in ischemic stroke characteristics in a rapidly developed country: results from the Korean Stroke Registry Study (secular trends in Korean stroke). Circ Cardiovasc Qual Outcomes. 2012; 5:327–334. PMID: 22474244.

26. Hong KS, Bang OY, Kim JS, Heo JH, Yu KH, Bae HJ, Kang DW, Lee JS, Kwon SU, Oh CW, Lee BC, Yoon BW. Stroke statistics in Korea: part II. Stroke awareness and acute stroke care, a report from the Korean Stroke Society and clinical research center for stroke. J Stroke. 2013; 15:67–77. PMID: 24324942.

27. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, Heo JH, Kwon SU, Oh CW, Lee BC, Kim JS, Yoon BW. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and clinical research center for stroke. J Stroke. 2013; 15:2–20. PMID: 24324935.