Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

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Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 - 22.8) for males and 25.1 years (95% CI: 24.4 - 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 - 19.9) vs. 26.3 years (95% CI: 24.5 - 28.1) among males, and 21.2 years (95% CI: 19.7 - 22.7) vs. 29.3 years (95% CI: 27.5 - 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 - 6.1) vs. 9.3 years (95% CI: 7.5 - 11.1) among males, and 5.3 years (95% CI: 3.7 - 6.9) vs. 10.3 years (95% CI: 8.3 - 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

Original languageEnglish
Article numbere0271110
Number of pages21
JournalPloS ONE
Issue number8
Early online date11 Aug 2022
Publication statusPublished - Aug 2022

Bibliographical note

Funding Information:
This study was supported by funding from Diabetes UK. In particular the following grants: 17/0005627 - received by HMC 8/0005786 - received by TMC. The funder had no role in designing the study or in analysing and interpreting data and results.

Data Availability Statement

The analysed data were provided de-identified, with approval from the Public Benefit and Privacy Panel (PBPP refs. 1617-0147), originally set up under Privacy Advisory Committee (PAC) 33/11, with approval from the Scotland A Research Ethics Committee (ref. 11/AL/0225). NHS data governance rules do not permit us to secondarily share the analysed data directly. However, bona fide researchers can apply to the Scottish Public Benefits Protection Committee for access to these data or get in contact with the Scottish Diabetes Research Network in order to gain further information on the data and legislations surrounding the access to the data. The Scottish Diabetes Research Network can be contacted via the following address: Diabetes Support Unit, Level 8, Ninewells Hospital, Dundee DD1 9SY, email: The Scottish Public Benefits Protection Committee provided detailed information and instructions on data access requests here: and be contacted via the following email address: For further information on NHS Scotland diabetes data provisioning see: The corresponding author can be contacted for any further genuine requests to audit the validity of the analyses. We are happy to share summary statistics for those wishing to conduct meta-analyses with other studies.


  • Aged
  • Diabetes Complications/complications
  • Diabetes Mellitus, Type 1/complications
  • Female
  • Humans
  • Life Expectancy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Scotland/epidemiology
  • Socioeconomic Factors


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