Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

Andreas Höhn; Stuart J. McGurnaghan; Thomas M. Caparrotta; Anita Jeyam; Joseph E. O’Reilly; Luke A. K. Blackbourn; Sara Hatam; Christian Dudel; Rosie J. Seaman; Joseph Mellor; Naveed Sattar; Rory J. McCrimmon; Brian Kennon; John R. Petrie; Sarah Wild; Paul M. McKeigue; Helen M. Colhoun; on behalf of the SDRN-Epi Group

doi:10.1371/journal.pone.0271110

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

Andreas Höhn^*, Stuart J. McGurnaghan, Thomas M. Caparrotta, Anita Jeyam, Joseph E. O’Reilly, Luke A. K. Blackbourn, Sara Hatam, Christian Dudel, Rosie J. Seaman, Joseph Mellor, Naveed Sattar, Rory J. McCrimmon, Brian Kennon, John R. Petrie, Sarah Wild, Paul M. McKeigue, Helen M. Colhoun, on behalf of the SDRN-Epi Group

^*Corresponding author for this work

School of Geography & Sustainable Development

Research output: Contribution to journal › Article › peer-review

Abstract

Background

We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes.

Methods

This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50.

Results

At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking.

Conclusions

In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

Original language	English
Article number	e0271110
Number of pages	21
Journal	PLoS ONE
Volume	17
Issue number	8
DOIs	https://doi.org/10.1371/journal.pone.0271110
Publication status	Published - 11 Aug 2022

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Höhn, A., McGurnaghan, S. J., Caparrotta, T. M., Jeyam, A., O’Reilly, J. E., Blackbourn, L. A. K., Hatam, S., Dudel, C., Seaman, R. J., Mellor, J., Sattar, N., McCrimmon, R. J., Kennon, B., Petrie, J. R., Wild, S., McKeigue, P. M., Colhoun, H. M., & on behalf of the SDRN-Epi Group (2022). Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018. PLoS ONE, 17(8), Article e0271110. https://doi.org/10.1371/journal.pone.0271110

@article{988d45a78714425787e63eb77b41cd5a,

title = "Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018",

abstract = "Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications. ",

author = "Andreas H{\"o}hn and McGurnaghan, {Stuart J.} and Caparrotta, {Thomas M.} and Anita Jeyam and O{\textquoteright}Reilly, {Joseph E.} and Blackbourn, {Luke A. K.} and Sara Hatam and Christian Dudel and Seaman, {Rosie J.} and Joseph Mellor and Naveed Sattar and McCrimmon, {Rory J.} and Brian Kennon and Petrie, {John R.} and Sarah Wild and McKeigue, {Paul M.} and Colhoun, {Helen M.} and {on behalf of the SDRN-Epi Group}",

note = "This study was supported by funding from Diabetes UK. In particular the following grants: 17/0005627 - received by HMC 8/0005786 - received by TMC. ",

year = "2022",

month = aug,

day = "11",

doi = "10.1371/journal.pone.0271110",

language = "English",

volume = "17",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "8",

}

Höhn, A, McGurnaghan, SJ, Caparrotta, TM, Jeyam, A, O’Reilly, JE, Blackbourn, LAK, Hatam, S, Dudel, C, Seaman, RJ, Mellor, J, Sattar, N, McCrimmon, RJ, Kennon, B, Petrie, JR, Wild, S, McKeigue, PM, Colhoun, HM & on behalf of the SDRN-Epi Group 2022, 'Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018', PLoS ONE, vol. 17, no. 8, e0271110. https://doi.org/10.1371/journal.pone.0271110

TY - JOUR

T1 - Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

AU - Höhn, Andreas

AU - McGurnaghan, Stuart J.

AU - Caparrotta, Thomas M.

AU - Jeyam, Anita

AU - O’Reilly, Joseph E.

AU - Blackbourn, Luke A. K.

AU - Hatam, Sara

AU - Dudel, Christian

AU - Seaman, Rosie J.

AU - Mellor, Joseph

AU - Sattar, Naveed

AU - McCrimmon, Rory J.

AU - Kennon, Brian

AU - Petrie, John R.

AU - Wild, Sarah

AU - McKeigue, Paul M.

AU - Colhoun, Helen M.

AU - on behalf of the SDRN-Epi Group

N1 - This study was supported by funding from Diabetes UK. In particular the following grants: 17/0005627 - received by HMC 8/0005786 - received by TMC.

PY - 2022/8/11

Y1 - 2022/8/11

N2 - Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

AB - Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

U2 - 10.1371/journal.pone.0271110

DO - 10.1371/journal.pone.0271110

M3 - Article

SN - 1932-6203

VL - 17

JO - PLoS ONE

JF - PLoS ONE

IS - 8

M1 - e0271110

ER -

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

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