Diabetes research and clinical practice · 2026
Global inequalities in premature mortality from type 1 diabetes: Country-level forecasting and a mortality-to-incidence ratio-based policy-gap analysis to 2030.
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Zhao Jun
Аннотация
BACKGROUND: Premature mortality from type 1 diabetes mellitus (T1DM) remains unequally distributed worldwide. Whether population-level mortality-to-incidence ratio (MIR) disparities will persist to 2030, and which countries are unlikely to achieve a T1DM-specific Sustainable Development Goal 3.4-aligned mortality-reduction benchmark, remain unclear.
METHODS: We conducted a country-level ecological time-series analysis of adults aged 30-69 years using age-standardized T1DM incidence and mortality estimates from 2000 to 2021. Income-group inequalities in incidence, mortality, and MIR were quantified, and trajectories to 2030 were projected using an XGBoost-based recursive forecasting framework. Model performance was assessed through temporal backtesting, rolling-origin validation, benchmark comparisons, and leave-one-country-out cross-validation. Empirical benchmark-attainment probabilities were estimated by resampling long-horizon forecast errors.
RESULTS: Historical median MIR was 0.142 in high-income countries, compared with 0.646, 0.640, and 0.566 in low-, lower-middle-, and upper-middle-income countries, respectively. XGBoost showed low validation errors for incidence, mortality, and MIR. Projected trajectories suggested persistent income-related MIR inequalities through 2030. Only 14 of 204 countries and territories had at least a 50 % benchmark-attainment probability; five were high-confidence achievers, whereas 158 were high-confidence non-attainers.
CONCLUSIONS: Global progress in reducing premature T1DM mortality appears insufficient and highly unequal.
METHODS: We conducted a country-level ecological time-series analysis of adults aged 30-69 years using age-standardized T1DM incidence and mortality estimates from 2000 to 2021. Income-group inequalities in incidence, mortality, and MIR were quantified, and trajectories to 2030 were projected using an XGBoost-based recursive forecasting framework. Model performance was assessed through temporal backtesting, rolling-origin validation, benchmark comparisons, and leave-one-country-out cross-validation. Empirical benchmark-attainment probabilities were estimated by resampling long-horizon forecast errors.
RESULTS: Historical median MIR was 0.142 in high-income countries, compared with 0.646, 0.640, and 0.566 in low-, lower-middle-, and upper-middle-income countries, respectively. XGBoost showed low validation errors for incidence, mortality, and MIR. Projected trajectories suggested persistent income-related MIR inequalities through 2030. Only 14 of 204 countries and territories had at least a 50 % benchmark-attainment probability; five were high-confidence achievers, whereas 158 were high-confidence non-attainers.
CONCLUSIONS: Global progress in reducing premature T1DM mortality appears insufficient and highly unequal.