Life expectancy following a cardiovascular event in individuals with and without type 2 diabetes: A UK multi-ethnic population-based observational study

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2023-07, Vol.33 (7), p.1358-1366
• Main Authors: Chudasama, Yogini V., Khunti, Kamlesh, Coles, Briana, Gillies, Clare L., Islam, Nazrul, Rowlands, Alex V., Seidu, Samuel, Razieh, Cameron, Davies, Melanie J., Samani, Nilesh J., Yates, Thomas, Zaccardi, Francesco
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Cardiovascular Diseases; Diabetes; Diabetes Mellitus, Type 2 - complications; England - epidemiology; Female; Humans; Life Expectancy; Male; Middle Aged; Prognosis; White People; Years of life lost
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2023.04.003

We aimed to evaluate the life expectancy following the first cardiovascular disease (CVD) event by type 2 diabetes (T2D) status and ethnicity. We used the Clinical Practice Research Datalink database in England (UK), linked to the Hospital Episode Statistics information, to identify individuals with and without T2D who survived a first CVD event between 1st Jan 2007 and 31st Dec 2017; subsequent death events were extracted from the Office for National Statistics database. Ethnicity was categorised as White, South Asian (SA), Black, or other. Flexible parametric survival models were used to estimate survival and predict life expectancy. 59,939 individuals with first CVD event were included: 7596 (12.7%) with T2D (60.9% men; mean age at event: 69.7 years [63.2 years in SA, 65.9 in Black, 70.2 in White]) and 52,343 without T2D (56.7% men; 65.9 years [54.7 in Black, 58.2 in SA, 66.3 in White]). Accounting for potential confounders (sex, deprivation, lipid-lowering medication, current smoking, and pre-existing hypertension), comparing individuals with vs without T2D the mortality rate was 53% higher in White (hazard ratio [HR]: 1.53 [95% CI: 1.44, 1.62]), corresponding to a potential loss of 3.87 (3.30, 4.44) life years at the age of 50 years in individuals with T2D. No evidence of a difference in life expectancy was observed in individuals of SA (HR: 0.82 [0.52, 1.29]; −1.36 [-4.58, 1.86] life years), Black (HR: 1.26 [0.59, 2.70]; 1.21 [-2.99, 5.41] life years); and other (HR: 1.64 [0.80, 3.39]; 3.89 [-2.28, 9.99] life years) ethnic group. Following a CVD event, T2D is associated with a different prognosis and life years lost among ethnic groups. •Limited evidence for the prognosis of individuals with cardiovascular disease (CVD) by type 2 diabetes (T2D) and ethnicity.•After first CVD, the largest life expectancy difference was in White ethnicity, (loss of 3.9 years) with vs without T2D.•Differences were non-significant in other ethnicity (3.9 years), Black (1.2 y), South Asian (-1.4 y) with vs without T2D.•Study shows the heterogeneous impact of T2D on life expectancy among individuals of different ethnicity who survived a CVD.