Cross‐country inequalities in disease burden and care quality of chronic kidney disease due to type 2 diabetes mellitus, 1990–2021: Findings from the global burden of disease study 2021

Abstract Aim To explore the trend of burden and care quality of chronic kidney disease due to type 2 diabetes mellitus (CKD‐T2DM) and their cross‐country inequalities from 1990 to 2021. Materials and Methods Data were from the Global Burden of Disease 2021 study. Disease burden and care quality were quantified using the disability‐adjusted life years rate and the quality‐of‐care index (QCI). Trend analyses of the age‐standardized disability‐adjusted life years rate (ASDR) and age‐standardized QCI from 1990 to 2021 were conducted using the estimated annual percentage change. The associations of disease burden and care quality with the socio‐demographic index (SDI) were explored. Cross‐country inequalities in disease burden and care quality were assessed using the slope index of inequality (SII) and concentration index. Results From 1990 to 2021, the global ASDR for CKD‐T2DM increased, while the age‐standardized QCI slightly decreased, with an estimated annual percentage change of 0.81 [95% confidence interval (CI): 0.75, 0.87] and −0.08 (95% CI: −0.09, −0.07). The ASDR escalated with increasing SDI, reaching a peak at mid‐level SDI, followed by a decrease. The age‐standardized QCI was higher with increasing SDI. Globally, ASDR concentrated on countries/territories with a lower SDI. The SII of ASDR was −96.64 (95% CI: −136.94, −56.35) in 1990 and −118.15 (95% CI: −166.36, −69.94) in 2021, with a concentration index of −0.1298 (95% CI: −0.1904, −0.0692) in 1990 and −0.1104 (95% CI: −0.1819, −0.0389) in 2021. In 1990 and 2021, countries/territories at higher SDI levels exhibited increased age‐standardized QCI, indicated by an SII of 15.09 (95% CI: 10.74, 19.45) and 15.75 (95% CI: 10.92, 20.59), and a concentration index of 0.0393 (95% CI: 0.0283, 0.0503) and 0.0400 (95% CI: 0.0264, 0.0536). Conclusions Our study highlights considerable disparities in the burden and care quality of CKD‐T2DM. Regions experiencing an increasing burden and a declining care quality simultaneously underscore the need for further research and tailored health interventions.