What question did this study set out to answer?

To assess trends and regional disparities in type 2 diabetes among women aged 55 and older.

May 7, 2026

Regional disparities and metabolic determinants of type 2 diabetes in women aged 55 and older

KZKexin ZhangTongji University CKChengxia KanPreventive Cardiology WXWenying XuTongji University

Key Points

To assess trends and regional disparities in type 2 diabetes among women aged 55 and older.
Used Global Burden of Disease data from 1990 to 2023
Quantified incidence, mortality, and DALYs for women with type 2 diabetes
Applied joinpoint regression for temporal trends analysis
Identified regional determinants using XGBoost machine learning model
Constructed a Quality-of-Care Index to evaluate healthcare performance
South Asia reported the highest burden of type 2 diabetes in 2023
Eastern Europe showed the largest long-term increases in incidence and mortality rates
High fasting plasma glucose, body mass index, and physical inactivity were key determinants
Distinct risk patterns were noted, such as air pollution and dietary issues across regions
Lower Quality-of-Care scores correlated with higher mortality and DALYs rates

Abstract

Objective: To assess long-term trends, regional disparities, determinants, and quality of care for type 2 diabetes mellitus (T2DM) among women aged 55 years or above worldwide. Methods: Using Global Burden of Disease 2023 data, we quantified incidence, mortality, and disability-adjusted life years (DALYs) attributable to T2DM among women aged 55 years or above from 1990 to 2023. Temporal trends were evaluated using joinpoint regression. Regional determinants were identified through explainable machine learning models (XGBoost with Shapley Additive Explanations). A Quality-of-Care Index, derived from mortality, disability, and prevalence indicators, was constructed to evaluate health care performance. Results: In 2023, South Asia recorded the largest absolute burden of T2DM among women aged 55 years or above, with 749,064 cases (95% uncertainty intervals UI 592,209-892,315), 274,542 deaths (171,620-381,640), and 8.11 million DALYs (5.82-10.43 million), followed by East Asia and high-income North America. From 1990 to 2023, Eastern Europe exhibited the steepest long-term increases in age-standardized incidence, mortality, and DALYs rates, with an average annual percent change of 2.49% for incidence and 3.97% for mortality. Mortality and DALYs burdens peaked among women aged 65-69 years. Across regions, high fasting plasma glucose, high body mass index, and low physical activity were the leading contributors to disease burden. Distinct regional risk patterns were observed, including air pollution in Asia, unhealthy dietary patterns in high-income North America, sedentary behavior in Oceania, and alcohol use in South Asia. Lower Quality-of-Care Index scores were strongly associated with higher mortality and DALYs rates, highlighting substantial inequities in diabetes care. Conclusions: The escalating burden of T2DM among women aged 55 years or older reflects interactions between biological aging and metabolic, behavioral, and environmental risks. Age-targeted prevention, improved care quality, and mitigation of modifiable exposures are critical to reduce diabetes-related disability globally.

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