Trends in mortality and hospitalisations for cardiovascular, kidney and liver disease in people with type 2 diabetes in England, 2009–2019

Abstract Aims To assess longitudinal trends in total and cause‐specific mortality rates and in hospitalisation rates for diabetes complications among people with type 2 diabetes in England between 2009 and 2019; and to assess how trends differ by patient characteristics. Materials and Methods A sequential cohort study of people with type 2 diabetes aged ≥20 years was performed using data from the National Diabetes Audit. Discretised Poisson regression models, adjusted for age, sex, ethnicity, socio‐economic deprivation and diabetes duration, were used to calculate total and cause‐specific mortality rates, as well as hospitalisation rates for myocardial infarction, stroke, heart failure, kidney and liver disease. Results Total mortality declined in people aged 20–74 years (rate ratio [RR] 0.96, 95% CI 0.95–0.97) and aged ≥75 years (0.93, 0.92–0.94) between 2009–2011 and 2018–2019, predominantly due to reductions in cardiovascular deaths. Over the same time period, in those aged 20–74 years, total mortality declined in people of South Asian (0.92:0.0.87–0.96) but was unchanged in people of White (1.00: 0.99–1.01) ethnicities. Total mortality declined more in people living in the least (0.91:0.88–0.94) compared to the most (0.97:0.95–1.00) deprived areas. A composite endpoint of cardiovascular hospitalisations and mortality increased between 2009–2011 and 2018–2019 in those aged 20–49 years (1.20:1.14–1.27) and 50–74 years (1.04:1.03–1.05) but declined in those aged ≥75 years (0.85:0.84–0.86). Rates of hospitalisation for kidney and liver disease increased in all age groups. Conclusions By examining longitudinal trends in mortality and hospitalisations according to different characteristics in people with type 2 diabetes in England, we have identified important targets for improvement through changes in health policy and care delivery.