Background and Aim: Since few contemporary studies have assessed prognosis in Aboriginals with type 2 diabetes (T2DM), we investigated the risk of all-cause mortality in community-based Aboriginals vs Anglo-Celts with T2DM.
Patients and Methods: The longitudinal Fremantle Diabetes Study Phase II includes 105 Aboriginal and 787 Anglo-Celt subjects with T2DM recruited between 2008 and 2011. This cohort was followed to death/census at end-March 2014. , a mean follow up of 4.3±1.2 (range 0.2-6.1) years.
Results: At baseline, the 892 patients had a mean±SD age of 65.7±11.5 years, 49% were male, and their median [inter-quartile range] diabetes duration was 8.0 [2.3-15.0] years. During follow-up, a similar proportion of Aboriginals and Anglo-Celts died (13.3% vs 10.4%, P=0.40). However, the age at death for Aboriginals was younger than for Anglo-Celts (59.1±14.0 vs 78.7±9.6 years, P<0.001). Cox proportional hazards modelling with age as the time-line showed that all-cause mortality was predicted by male sex (hazard ratio (95% CI): 2.46 (1.57-3.88)), current smoking (3.89 (2.22-6.81)), eGFR <45 ml/min/1.73m2 (2.07 (1.36-3.15)), whilst being married/in a de facto relationship was protective (0.53 (0.34-0.83)). After adjusting for this most parsimonious model, Aboriginals were 6 times more likely to have died than Anglo-Celts (6.05 (3.12-11.73)).
Conclusions: These Australian urban community-based data show that Aboriginals have substantially increased mortality, losing an average of 20 years of life vs Anglo-Celts. Multivariate analyses suggest that this situation could be improved by targeting smoking cessation and renoprotection.