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Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study

  • Hongjiang Wu
  • Eric S. H. Lau
  • Ronald C. W. Ma
  • Alice P. S. Kong
  • Sarah H. Wild
  • William Goggins
  • Elaine Chow
  • Wing-Yee So
  • Juliana C. N. Chan
  • Andrea O. Y. LukEmail author



The aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016.


The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes.


Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45–74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20–44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change [AAPC]: −3.2% [95% CI −7.3%, 1.0%]) and women (AAPC: −1.2% [95% CI −6.5%, 4.4%]). The SMRs in people aged 20−44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016.


Absolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.


All-cause mortality Cause-specific mortality Diabetes Standardised mortality ratios Trends 



Average annual per cent change


Annual per cent change


Cardiovascular disease


Hong Kong Diabetes Surveillance Database


Standardised mortality ratio



We acknowledge the Hong Kong Hospital Authority for providing anonymised clinical data for research.

Contribution statement

All authors made substantial contributions to conception and design, revised the article critically for important intellectual content and approved the final version to be published. HW additionally contributed to analysis and interpretation of data, and drafted the article. AOYL additionally contributed to acquisition of data. AOYL is the guarantor of this work, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


HW is partially supported by a research grant from the Asia Diabetes Foundation.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2019_5074_MOESM1_ESM.pdf (390 kb)
ESM (PDF 389 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Hongjiang Wu
    • 1
  • Eric S. H. Lau
    • 1
  • Ronald C. W. Ma
    • 1
    • 2
    • 3
  • Alice P. S. Kong
    • 1
    • 2
    • 3
  • Sarah H. Wild
    • 4
  • William Goggins
    • 5
  • Elaine Chow
    • 1
  • Wing-Yee So
    • 1
    • 6
  • Juliana C. N. Chan
    • 1
    • 2
    • 3
  • Andrea O. Y. Luk
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, Prince of Wales HospitalShatinPeople’s Republic of China
  2. 2.Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong Special Administrative RegionPeople’s Republic of China
  3. 3.Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong Special Administrative RegionPeople’s Republic of China
  4. 4.Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
  5. 5.Jockey Club School of Public Health and Family MedicineThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong Special Administrative RegionPeople’s Republic of China
  6. 6.Hong Kong Hospital AuthorityHong Kong Special Administrative RegionPeople’s Republic of China

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