Time trends of diabetes in Colombia from 1998 to 2015: the recent stagnation in mortality, and educational inequities

Aims: To study the observed trends in Diabetes Mellitus (DM) mortality rates according to educational level, age group and sex in Colombia between 1998 and 2015. Methods: A cross-sectional study was conducted based in official databases. Age-standardized mortality rates were calculated by age-gropus, educational level, sex and year. Rate Ratios (RR) were estimated with higher educational level as reference. The Relative Index of Inequality (RII) was estimated. Joinpoint regressions were applied to identify inflexion points in mortality trends, and Percent Annual Change (APC) between inflexion points. Results: 124,198 deaths caused by DM among adults (25+ years) were analysed, 57% among women (71,093); 74% of deaths occurred among those older than 45 years, especially senior adults (65+). The highest adjusted mortality rates were for those with primary and secondary educational levels. The highest mortality occurred in adult women (65 years or more) with primary education level. Relative Index of Inequality was higher for women than for men along the period. Conclusions: Educational levels were found to be strongly associated with death by DM in adults (25+). Intersectoral actions are required to influence the risk factors and to improve the treatment of the disease in groups with lower levels of education. (C) 2020 Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe.