Tobacco exposure remains a major modifiable contributor to the burden of type 2 diabetes mellitus (T2DM), particularly among older adults. A global analysis published in the Journal of Diabetes Research assessed deaths and disability-adjusted life years (DALYs) attributable to tobacco exposure among individuals aged 55 years and older with T2DM.
The study analyzed Global Burden of Disease (GBD) 2021 data from 204 countries and territories covering the period 1990 to 2021. Burden counts and rates per 100,000 population were evaluated. The analysis incorporated estimated annual percentage change (EAPC) calculations and applied age-period-cohort (APC) modeling, frontier analysis, and Bayesian age-period-cohort (BAPC) forecasting models.
Globally, tobacco-attributable T2DM deaths increased by 101.10%, while DALYs increased by 140.38% during the study period. Despite this rise in absolute burden, the mortality rate declined by 9.13%. Regions with middle and low-middle sociodemographic index (SDI) carried the highest burden. High-SDI regions showed the largest reductions in burden rates, whereas low-middle-SDI regions experienced the greatest relative increases.
Sex- and age-based analyses showed higher mortality and DALY counts in males, while females demonstrated greater reductions in burden trends. Age-period-cohort modeling indicated that advancing age was associated with higher risks of tobacco exposure-attributable T2DM outcomes, whereas younger birth cohorts showed lower risks.
Forecasting models suggest that the mortality rate will continue to decline, reaching 9.25 per 100,000 population aged ≥55 years in 2030 (95% CI 8.64-9.85) and 8.57 per 100,000 in 2042 (95% CI 6.89-10.24). The analysis also showed substantial geographic, sex, and age disparities in tobacco-attributable T2DM burden, with low-middle-SDI regions bearing the greatest increases. These findings highlight the need for targeted interventions in these regions, while tobacco control strategies implemented in high-SDI regions may provide scalable approaches to reduce this preventable burden.
