Background Diabetes has been increasing worldwide and is now among the 10 leading causes of death globally. Diabetic kidney disease (DKD), a complication of poorly managed diabetes, is related to high mortality risk. To better understand the situation in the Americas region, we evaluated diabetes and DKD mortality trends over the past 20 years. Methods We analysed diabetes and DKD mortality for 33 countries in the Americas from 2000 to 2019. Data were extracted from the World Health Organization (WHO) Global Health Estimates and the World Population Prospects, 2019 Revision, estimating annual age-standardized mortality rates (ASMR) and gaps in the distribution of diabetes and DKD mortality by sex and country. Trend analyses were based on the annual average percentage of change (AAPC). Results From 2000 to 2019, the overall mortality trend from diabetes in the Americas remained stable [AAPC: -0.2% (95% CI: -0.4%–0.0%]; however, it showed important differences by sex and by country over time. By contrast, DKD mortality increased 1.5% (1.3%–1.6%) per year, rising faster in men than women, with differences between countries. Central America, Mexico and the Latin Caribbean showed significant increases in mortality for both diseases, especially DKD. In contrast in North America, diabetes mortality decreased whereas DKD mortality increased. Conclusions The increase in DKD mortality is evidence of poorly controlled diabetes in the region. The lack of programmes on prevention of complications, self-care management and gaps in quality health care may explain this trend and highlight the urgent need to build more robust health systems based on primary care, prioritizing diabetes prevention and control.

中文翻译：

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糖尿病死亡率：2000年至2019年美洲的趋势和多国分析

背景 糖尿病在全球范围内呈上升趋势，现已成为全球十大死亡原因之一。糖尿病肾病（DKD）是糖尿病管理不善的并发症，与高死亡风险有关。为了更好地了解美洲地区的情况，我们评估了过去 20 年的糖尿病和 DKD 死亡率趋势。方法 我们分析了 2000 年至 2019 年美洲 33 个国家的糖尿病和 DKD 死亡率。数据摘自世界卫生组织 (WHO) 全球健康估计和世界人口展望 2019 年修订版，估计年度年龄标准化死亡率 (ASMR) ）以及糖尿病和 DKD 死亡率按性别和国家分布的差异。趋势分析基于年平均变化百分比 (AAPC)。结果 2000 年至 2019 年，美洲糖尿病总体死亡率趋势保持稳定 [AAPC：-0.2%（95% CI：-0.4%–0.0%）；然而，随着时间的推移，不同性别和不同国家的死亡率存在显着差异。相比之下，DKD 死亡率每年增加 1.5% (1.3%–1.6%)，男性上升速度快于女性，各国之间存在差异。中美洲、墨西哥和拉丁美洲加勒比地区这两种疾病的死亡率显着增加，尤其是 DKD。相比之下，在北美，糖尿病死亡率下降，而 DKD 死亡率上升。结论 DKD 死亡率上升是该地区糖尿病控制不佳的证据。缺乏并发症预防、自我护理管理和优质医疗保健方面的差距可能会导致糖尿病死亡率增加。解释这一趋势并强调迫切需要建立基于初级保健的更强大的卫生系统，优先考虑糖尿病的预防和控制。