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Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up
  1. Leo Niskanen1,
  2. Timo Partonen2,
  3. Anssi Auvinen3,
  4. Jari Haukka4,5
  1. 1Central Hospital Stomach Centre, Helsinki University, Helsinki, Finland
  2. 2Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Helsinki, Finland
  3. 3Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
  4. 4Public Health, University of Helsinki, Helsinki, Finland
  5. 5Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  1. Correspondence to Jari Haukka, University of Helsinki, Helsinki, Finland; jari.haukka{at}


Background Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emergence of other diabetes-related complications and ultimately to diversification of the causes of death.

Methods The study population of this observational historic cohort study consisted of subjects with DM, who had purchased for at least one insulin prescription and/or one oral antidiabetic between January 1, 1997 and December 31, 2010 (N=199 354), and a reference population matched by age, sex and hospital district (N=199 354). Follow-up was continued until December 31, 2017. All-cause and cause-specific mortality (cancer, CHD and stroke) was analysed with Poisson and Cox’s regression. Associations between baseline medications and mortality were analysed using LASSO (Least Absolute Shrinkage and Selection Operator) models.

Results The mortality rates were significantly elevated among the patients with DM. However, the relative risk of all-cause mortality between the DM and reference populations tended to converge during the follow-up. The lowering trend was most apparent in CHD mortality. The difference between DM and reference populations in stroke mortality vanished with a later entrance to the follow-up period. There were a few differences between DM and no-DM groups with respect to how baseline medications were associated with mortality.

Conclusions The gap between the mortality of patients with diabetes compared to subjects who are non-diabetic diminished markedly during the 21-year period. This was driven primarily by the reduced CHD mortality.

  • Cohort studies
  • Coronary heart disease
  • Diabetes
  • Avoidable deaths
  • Mortality

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  • Contributors All the authors have made substantial contributions: conception and design (LN, AA, TP and JH), data acquisition and analysis (JH and AA), reporting and interpretation (LN, AA, TP and JH). They all participated in drafting the article or revising it critically for important intellectual content, and all have approved the final version.

  • Funding CARING study (EU grant agreement number 282526).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available from Statistics Finland, the Social Insurance Institution and the Finnish Cancer Registry, but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Statistics Finland, the Social Insurance Institution and the Finnish Cancer Registry.