Introduction: Large-scale prospective studies of diabetes and cause-specific mortality have been conducted mainly in high-income countries, where there is good access to healthcare. However, there is limited evidence on the effect of diabetes on mortality in low- and middle-income countries, such as Cuba.
Methods: From 1996-2002, we recruited 146,556 participants (aged ≥30) from the general population in Cuba into a prospective cohort study. We recorded the presence or absence of previously diagnosed diabetes, and monitored for deaths through December 31st, 2015. We estimated adjusted hazard ratios (HR) for cause-specific mortality at ages 30-84 years among participants who had diabetes at recruitment vs. those who did not have diabetes at recruitment; participants with prior chronic disease other than diabetes were excluded from the analyses.
Results: At recruitment, the overall prevalence of diabetes was 4% in men and 7% in women, and the mean age was 53 (SD13) years. Previously diagnosed diabetes was associated with about twice the risk of all-cause mortality (HR 1.89 [95% CI 1.79-1.99]; mean age at death 70 [SD12]). The association was stronger at younger ages, but did not differ by sex: HR 2.68 (2.29-3.14) at 30-59 years, 2.20 (2.03-2.38) at 60-74 years, and 1.56 (1.44-1.68) at 75-84 years. Diabetes was strongly associated with mortality from renal, cardiovascular and respiratory diseases, but not with cancer. The excess mortality associated with diabetes accounted for ∼10% of all premature deaths (<75 years) in Cuba for 2015; mostly from cardiovascular disease.
Conclusion: Despite limited resources in Cuba, the association of diabetes with all-cause mortality was similar to high-income countries and less extreme than in many other middle-income countries.
S.J.C. Charles: None.