Oral presentation vid EASD

Mortality and Causes of Death in Type 1 and Type 2 Diabetes in Sweden: Nationwide Matched Cohort Analyses (2005-2024)

S.P.O. Jansson1, M. Carlberg2, L. Bennet3, C. Östgren4, O. Rolandsson5, P. Wändell6;
1School of Medical Science, Orebro University, Orebro, Sweden, 2Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro university,
Örebro, Sweden, 3Lund University, Malmö, Sweden, 4Department of Health, Medicine and Caring Sciences, General Practice, Linköping University, Linköping,
Sweden, 5Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden, 6Department of Neurobiology, Care Sciences and
Society, Karolinska Institutet, Huddinge, Sweden, Stockholm, Sweden.

Abstract:

Background and aims:

Diabetes is associated with increased mortality, but contemporary large-scale comparisons between type 1 and type 2 diabetes and
matched controls remain limited.

This study aimed to quantify all-cause mortality, long-term survival, and cause-specific mortality in individuals with type 1 and
type 2 diabetes compared with matched controls without diabetes, including stratified analyses across sociodemographic factors.

Materials and methods:

Nationwide register-based cohort analyses were conducted using Swedish data from 2005-2023 with follow-up until December 31,
2024. Individuals with type 1 diabetes (n=67,245) and type 2 diabetes (n=794,466) were matched to controls without diabetes.

Cox proportional hazards models
were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CI), controlling for age, sex, foreign background, marital status, and education.
Kaplan-Meier methods were applied for survival analyses, and cause-specific mortality distributions were examined.

Results:

All-cause mortality was significantly higher in both diabetes types.

Adjusted HR for type 1 diabetes was 1.81 (95% CI 1.78-1.84), with similar elevations in
men (1.77, 1.73-1.82) and women (1.87, 1.81-1.92). Higher relative risks were observed in individuals born in Sweden with two foreign-born parents (2.60, 2.11-
3.20) and those who were single (2.11, 2.03-2.20). Across education levels, HRs ranged from 1.63 (1.58-1.68) in low to 1.96 (1.91-2.02) in mid education. For type 2
diabetes, the adjusted HR was 1.28 (1.27-1.28), consistent across men (1.27, 1.26-1.27) and women (1.29, 1.28-1.30). Stratified analyses showed increased risks in
individuals born in Sweden with two foreign-born parents (1.63, 1.51-1.76), married individuals (1.35, 1.34-1.36), and those with higher education (1.42, 1.40-1.44).
Survival was lower in diabetes. For type 1 diabetes, 1-, 5-, and 10-year survival was 99.6%, 95.8%, and 89.5% compared with 99.8%, 97.2%, and 93.4% in controls.

For type 2 diabetes, survival was 99.1%, 89.8%, and 74.2% versus 99.1%, 90.6%, and 78.4%.Cause-of-death analyses showed a predominance of cardiovascular
and renal causes in diabetes. In type 1 diabetes, ischemic heart disease (30.8%), heart failure (21.6%), and chronic kidney disease (17.7%) were more common than
in controls, whereas cancer contributed less frequently. In type 2 diabetes, heart failure (27.2%), ischemic heart disease (25.0%), and chronic kidney disease
(12.8%) were also overrepresented.

Conclusion:

Both type 1 and type 2 diabetes are associated with significantly increased mortality compared with matched controls, with a stronger relative effect
in type 1 diabetes.

Elevated adjusted HRs across sociodemographic strata and the predominance of cardiovascular and renal causes underscore the need for
intensified, equitable prevention and management strategies.

Author Disclosure Information:
S.P.O. Jansson: None.

Clinical Trial Registration Number (Complete):
: No
: N/A

Grant Acknowledgement (Complete):
No

Other/Additional Grant  : No

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