Infection Is the Third-Leading Cause of Death in T2D

TOPLINE:

People with type 2 diabetes (T2D) die from infections at a higher rate than similar people without diabetes, and the overall burden appears greater than previously reported.

Deaths from infections as an underlying cause recorded on death certificates represent the third-largest group after cardiovascular disease and cancer, respectively, accounting for about 13% of all deaths among people with T2D.

METHODOLOGY:

• Data analysed for 509,403 people aged 41-90 years with T2D who were alive on January 1, 2015, in the Clinical Practice Research Datalink, matched to 976,431 people without diabetes on age, sex, and ethnicity.
• Recorded underlying cause of death was identified through national-linked mortality data, with infection-related deaths counted across all ICD-10 (10th revision of the International Classification of Diseases) chapters, not just infection chapters A00-B99.

TAKEAWAY:

• During 2015-2019, a total of 85,367 (16.8%) people with T2D aged 41-90 years died, compared with 10.9% of the matched non-diabetes group (hazard ratio, 1.65; 95% CI, 1.64-1.66), ranging from 2.95 (2.75-3.17) for ages 41-50 years to 1.39 (1.38-1.41) for ages 81-90 years.
• Among all deaths, the top three causes were cardiovascular (29.7% in T2D, 24.4% in non-diabetes), cancer (26.9% and 31.6%, respectively), and all infections including pneumonia (13.0% and 12.0%, respectively).
• By contrast, the proportion of deaths from the infection-specific ICD-10 chapters (A00-B99) was much smaller (1.2% and 1.0%, respectively).
• In sensitivity analysis only counting infection deaths from ICD-10 chapters A00-B99, the estimated crude mortality rate per 1000 person-years was 0.45 for T2D vs 0.22 for non-diabetes, with estimated hazard ratio 2.09 (1.95-2.25).
• Among those who died, nearly a third with T2D (31.0%) have an infection coded anywhere on the certificate (29.8% in non-diabetes).
• When the underlying cause was listed as non-infective, the proportions listing sepsis elsewhere as a contributing were 3.2% for T2D vs 2.5% for non-diabetes.

IN PRACTICE: 

“Studies potentially under-estimate the true burden of infection-related mortality since they rely on clinical coding systems primarily structured by body system, and by only focusing on underlying cause,” the authors wrote. “Our study suggests whether underlying or contributory, infection-related deaths are common major causes or contributors to diabetes-related mortality. Despite this, the risk of infections is barely mentioned in T2D guidelines. Increased awareness by both patients and clinicians might enhance health seeking behaviour, result in prompter diagnosis and preventative treatment, and reduce the risk of serious infections that can be fatal,” they added.

SOURCE:

Conducted by Iain M. Carey, senior lecturer in Epidemiology in the Population Health Research Institute, St. George’s, University of London, UK, and colleagues, the study was published online on November 27, 2024, in The Lancet Regional Health-Europe. 

LIMITATIONS:

Only people aged 41-90 years at the start of follow-up in 2015 were included. Some people may have been lost to follow-up.

DISCLOSURES:

The study was funded by the National Institute for Health and Care Research. Iain M. Carey has no disclosures. One co-author listed several industry ties.