Sex differences in prevalence normalized mortality and risk attributable mortality indices for type 2 diabetes across...

To characterize sex-specific prevalence-normalized mortality and modelled risk-attributable mortality patterns for type 2 diabetes across the 27 European Union member states METHODS: We conducted an ecological analysis of Global Burden of Disease 2023 modelled estimates at two benchmark years, 2011 and 2021. Age-standardized mortality and prevalence rates were combined as a prevalence-normalized mortality ratio. Risk-attributable mortality was normalized to prevalence as a risk-attributable prevalence-normalized mortality index. Approximate intervals assumed independence between numerator and denominator and between sexes; country-level sex comparisons used Benjamini-Hochberg false discovery rate correction.

The unweighted country mean age-standardized mortality rate was higher in 2021 than in 2011, changing from 12.02 to 14.32 per 100,000 in men and from 8.84 to 10.08 per 100,000 in women; the corresponding prevalence means increased from 4,131.6 to 4,660.2 and from 2,875.3 to 3,178.6 per 100,000. Mean prevalence-normalized mortality changed modestly. No country-level sex comparison remained significant after false-discovery-rate correction. Tobacco-related indices were higher in men in all 27 countries and met the FDR criterion in 23 under the independence approximation; no other risk family contained corrected significant differences.

Across-country means describe member states rather than the population-weighted European Union. The tobacco-related index was consistently higher in men, a pattern compatible with established sex differences in tobacco exposure. Statistical evidence depends on unverified covariance assumptions. All indices are ecological summaries of modelled rates and must not be interpreted as individual mortality probabilities, causal effects, or evidence of independent sex-specific biological mechanisms.