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The Swedish Childhood Diabetes Study: a seven-fold decrease in short-term mortality?
G Sartor1, L Nyström, G Dahlquist
1Department of Internal Medicine, County Hospital, Halmstad, Sweden.
Insights
Swedish children with Type 1 diabetes (T1D) show a doubled mortality risk compared to the general population. This increased risk, particularly for males, persists despite good healthcare access, highlighting ongoing challenges in T1D management.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Type 1 diabetes (T1D) management and outcomes in pediatric populations are critical public health concerns.
- Sweden maintains a comprehensive national registry for newly diagnosed T1D cases in children since 1977.
Purpose of the Study:
- To assess the short-term mortality rates and causes of death in Swedish children diagnosed with Type 1 diabetes.
- To compare the mortality risk in this pediatric T1D cohort with the general Swedish population.
Main Methods:
- Analysis of a national Swedish registry data for children (0-14 years) diagnosed with T1D between July 1, 1977, and December 31, 1985.
- Calculation of overall mortality rates and standardized mortality ratios (SMR) by sex.
- Review of causes of death for registered patients.
Main Results:
- Ten deaths (0.75 per 1000 patient-years) occurred among 3228 registered children with T1D.
- The overall standardized mortality ratio (SMR) was 2.09 for both sexes combined, indicating a 2.09-fold increased mortality risk compared to the general population.
- Mortality risk was significantly elevated for males (SMR = 2.61) but not for females.
- Five deaths were attributed to diabetes, while the other five were due to accidents, other diseases, or were uncertain.
Conclusions:
- Despite a relatively low mortality rate compared to previous studies, short-term mortality remains significantly elevated in Swedish children with Type 1 diabetes.
- The increased mortality risk, especially in males, persists even in a setting with excellent socioeconomic status, patient education, and free healthcare access.
- These findings underscore the need for continued efforts to improve T1D management and reduce mortality in pediatric patients.
Abstract:
Since 1 July 1977 all Swedish children aged 0-14 years with newly diagnosed Type 1 diabetes have been recorded on a central register. Out of 3228 patients registered up to 31 December 1985, 10 children (seven boys) had died during this time period. The overall mortality was 0.75 per 1000 patient-years. When compared with the general population the standardized mortality ratio (SMR) for both sexes was 2.09 (95% confidence limits 1.14-3.83). When analysed separately for sex, the higher mortality remained significant for males only (SMR = 2.61, 1.28-5.32). Five deaths were most probably due to diabetes and the remaining five were due to accidents, other diseases and, in one case, not identifiable with certainty. In comparison with previous studies there was a very low mortality in young-onset diabetic patients. However, short-term mortality is still significantly raised even in a country with a good economic and educational patient status and easy access to free hospital care.