Global burden of deaths and DALYs attributable to smoking in Middle-Aged and elderly patients with type 2 Diabetes, 1990-2021: A systematic analysis of the GBD 2021 study.

BACKGROUND

Type 2 diabetes mellitus (T2DM) represents a global health crisis, with smoking being a key risk factor, especially in middle-aged and elderly populations. However, comprehensive insights into the global burden of smoking-attributable mortality and disability-adjusted life years (DALYs) in these patients remain scarce.

OBJECTIVE

This study aims to quantify the global burden of smoking-related deaths and DALYs in middle-aged and elderly T2DM patients from 1990 to 2021, analyzing regional, gender, and age disparities, SDI associations, and future trends. METHOD: Using GBD 2021 data across 204 countries/territories, we assessed numbers and rates, estimated annual percentage changes, and employed age-period-cohort modeling, frontier analysis, and ARIMA forecasting.

RESULTS

Global deaths from T2DM attributable to smoking rose by 89.16%, with DALYs increasing 133.30%, though death rate declined 14.53%. Middle- and low-middle SDI regions faced the highest burden. High-SDI regions showed the steepest rate declines, while low-middle SDI regions showed the largest relative increases. Males had higher mortality and DALYs than females, with greater rate declines in females. Age-period-cohort analysis linked older age (≥ 75 years) to higher risks, while younger cohorts showed lower risks. Frontier analysis identified middle-SDI countries (e.g., Kiribati) as deviating most from optimal performance, versus high-SDI nations (e.g., Netherlands). Projections to 2036 suggest stable rates, with potential female mortality declines.

CONCLUSIONS

Smoking-related T2DM burden varies significantly by region, gender, and age, urging targeted interventions in low-middle SDI regions. High-SDI tobacco control strategies offer scalable models to reduce this preventable burden.