Hierarchical Analysis of Age, Period, and Cohort Effects on Diabetes Mellitus Mortality in Colombia, 1983-2022

Background: Diabetes mellitus (DM) mortality in Colombia has varied over time, yet the individual and contextual factors driving these changes have been scarcely explored. This study aimed to analyze the associations of age, area of death, period, and birth cohort on DM mortality. Methods: Analytical, cross-sectional study based on mortality records and population projections from the statistics department. DM deaths were identified using ICD-9 and ICD-10 codes, grouped by age (A), period (P), cohort (C), sex, and area of death (urban/rural) in five-year intervals. A hierarchical APC-Cross-Classified Random Effects Model (HAPC-CCREM) with random intercepts was applied, using a negative binomial regression (log link function). Sex and age were included as fixed-effect predictors (level 1) estimating Mortality Rate Ratios (MRR). Period and cohort groups were included as contextual random effects (level 2) in a cross-classified structure interacting with the area of death. Population projections were incorporated as an offset term. Analyses were conducted in R with the glmmTMB package. Results: Sex and age were statistically significantly associated with DM mortality. Women exhibited a higher mortality rate than men (MRR: 1.21; 95% confidence interval (CI): 1.16–1.26). Additionally, mortality increased with age, with an MRR of 0.06 (95% CI: 0.05–0.08) for ages 0–4 and 87.05 (95% CI: 71.43–106.08) for ages 85 years and older, compared to the 40–44 year-old age group. Regarding random period effects, DM mortality was consistently higher in urban areas, with an increase until 1998–2002, followed by a decrease from 2003 to 2017, and a subsequent rise in 2018–2022. For random cohort effects, mortality was higher in urban areas up to the 1963–1967 cohort. However, in more recent cohorts, mortality has been higher in rural areas. Conclusions: Public health strategies to reduce DM mortality should address regional differences and prioritize healthy aging.

• Autores: Pérez Bedoya, Juan Pablo; Pérez Aguirre, Carlos Andrés; Barengo, Noël Christopher; Díaz Valencia, Paula Andrea
• Tipo de recurso: http://purl.org/coar/resource_type/c_18co
• Fecha de publicación: 2025
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/46317
• Acceso en línea: https://hdl.handle.net/10495/46317
• Palabra clave: Diabetes Mellitus - Mortalidad; Diabetes Mellitus - Mortality; Factores de Riesgo; Risk Factors; Estrategias de Salud; Health Strategies; Estudio Observacional; Observational Study; Distribución por Edad y Sexo; Age and Sex Distribution; https://id.nlm.nih.gov/mesh/D003920; https://id.nlm.nih.gov/mesh/D012307; https://id.nlm.nih.gov/mesh/D064888; ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-sa/4.0/