Trends in All-Cause and Cause-Specific Mortality in Older Adults With and Without Diabetes-A Territory-Wide Analysis in One Million Older Adults in Hong Kong

Aims Direct comparisons of population-level trends in all-cause and cause-specific mortalities among older adults with and without diabetes are lacking. Methods We performed a territory-wide analysis of 1,142,000 unique older adults aged ≥65 years (31.7% with diabetes) with at least one attendance in the Hong Kong Hospital Authority in 2014-2018. We used Joinpoint regression to describe trends of age- and sex-standardised all-cause and cause-specific mortalities (cardiovascular disease [CVD], cancer, and non-CVD and non-cancer) in older adults with and without diabetes. Results All-cause mortality decreased in older adults with (average annual percentage change [AAPC] = -1.6, 95% confidence interval [-2.7,-0.4]) and without (AAPC = -3.1 [-4.2,-2.1]) diabetes. Largest declines were seen for CVD-cause mortalities for people with and without diabetes (AAPC = -5.5 [-6.8, -4.1] vs AAPC = -5.8 [-8.6, -2.9] respectively). Cancer-cause mortalities were similar in both groups with no change. Men with diabetes showed less favourable improvements. An increasing mortality trend was seen only in the 65-69 age-group regardless of diabetes status. Conclusions Mortality continued to decline in older adults with and without diabetes, mainly driven by a decline in CVD deaths, with no narrowing of the mortality gap. Our findings call for continued actions to address excess mortalities especially in males with diabetes and younger older adults.