Time Trends in Liver-Related Mortality in People With and Without Diabetes

Stefano Ciardullo, Gabriella Morabito, Federico Rea, Laura Savaré, Gianluca Perseghin, Giovanni Corrao
The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 10, October 2024, Pages 2513–2519
https://doi.org/10.1210/clinem/dgae182

Abstract

Context

Patients with diabetes are at increased risk of dying from liver-related events, but little is known on whether this increased risk has changed in recent years.

Objective

The aim of the present study is to describe time trends in cause-specific liver-related mortality in people with and without diabetes from the general Italian population.

Methods

Data were retrieved from the health care utilization databases of Lombardy, a region of Italy that accounts for about 16% (almost 10 million) of its population. Annual cause-specific mortality rates and proportionate mortality were computed among individuals with and without diabetes from 2010 to 2019. Liver-related deaths were categorized as viral, alcohol related, and nonviral nonalcohol related (NVNA).

Results

Liver diseases were responsible for 2% and 1% of deaths in people with and without diabetes (2019). Among patients with diabetes, the crude mortality rate for liver diseases decreased from 1.13 to 0.64 deaths per 1000 person-years from 2010 to 2019. The largest proportion of liver-related deaths was attributable to NVNA diseases and it increased from 63% in 2010 to 68% in 2019, with a corresponding relative reduction of viral causes (from 27% to 23%). The standardized mortality ratio for patients with diabetes was 3.35 (95% CI 2.96–3.76) for NVNA, 1.66 (95% CI 1.33–2.01) for viral hepatitis, and 1.61 (95% CI 1.13–2.17) for alcoholic liver disease and it remained relatively stable over time. Excess mortality risk in patients with diabetes for liver-related mortality was higher than for cardiovascular mortality and cancer.

Conclusion

While liver-related mortality rates decreased significantly among patients with diabetes, NVNA causes made up the majority of cases. Excess mortality for liver-related causes in patients with diabetes compared with controls remained constant in the studied period.

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