Bayesian Age-Period-Cohort Prediction of Mortality of Type 2 Diabetic Kidney Disease in China: A Modeling Study

BackgroundThe burden of type 2 diabetic kidney disease (DKD) continues to rise in China. We analyzed time trends in DKD mortality and associations with age, period, and birth cohort from 1990 to 2019, made projections up to 2030, and examined the drivers of deaths from DKD.Methods and FindingsThe number of DKD deaths in China from 1990 to 2019 was obtained from the GBD 2019. We used age-period-cohort modeling to estimate age, period, and cohort effects in DKD mortality between 1990 and 2019. We calculated net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rates), period, and cohort relative risks. We used Bayesian age-period-cohort analysis with integrated nested Laplace approximations to project future age-specific DKD death cases from 2020 to 2030. We used a validated decomposition algorithm to attribute changes in DKD deaths to population growth, population aging, and epidemiologic changes from 1990 to 2030. From 1990 to 2019, the age-standardized mortality rate of DKD in China was relatively stable, but the absolute number of DKD deaths showed a noticeable increasing trend. The overall annual percentage change (net drift) was -0.75% (95% confidence interval, CI: -0.93 to -0.57) for males and -1.90% (95% CI, -2.19 to -1.62) for females. The age-specific annual percentage changes (local drifts) were below zero in all age groups from 1990 to 2019 except for males aged above 65 to 69 years, and for females aged above 70 to 74 years. The risk of DKD deaths increased exponentially with age for both sexes after controlling for period deviations. The Bayesian age-period-cohort analysis projects that there would be 88,803 deaths from DKD in 2030, increased by 224.2% from 1990. Despite a decrease in age-specific DKD death rates, the reduction would be entirely offset by population aging.ConclusionsAlthough China has made progress in reducing DKD deaths, demographic changes have entirely offset the progress. The burden of DKD deaths is likely to continue increasing. Our findings suggest that large-scale screening is imperative for DKD control and prevention, particularly for high-risk groups.