2型糖尿病的普遍性在年轻和老年人中都有增加。我们研究了与年龄特定的关联和人群可归因因素（PAFs）以及患有2型糖尿病的人群中所有因死亡和导致死亡的风险因素。我们分析了2000年1月至2019年12月期间参加香港全地域糖尿病并发症筛查计划的360,202名中国2型糖尿病患者的数据。我们比较了8种风险因素的危险比和PAFs，其中包括三种主要合并症（心血管疾病[CVD]，慢性肾脏疾病[CKD]，全身癌症）和五种可改变的风险因素（亚临床HbA1c，亚临床血压，亚临床低密度脂蛋白胆固醇，吸烟和亚临床体重），针对4个年龄组（18至54岁，55至64岁，65至74岁和≥75岁）进行死亡率的比较。随访期中位数为6.0年，共有44,396人死亡，癌症，CVD和肺炎是主要的死因。尽管老年人的绝对死亡风险更高（18至54岁人群每10,000人年的粗病死率为59.7，而≥75岁人群为596.2），但大多数风险因素与所有因和导致死亡的相对风险在年轻人中更高，在相互调整了8种风险因素和其他潜在混淆因素包括性别，糖尿病持续时间，脂质谱以及药物使用之后。这8种风险因素在年轻的时期（PAF：51.6％，95％置信区间[CI] [39.1％，64.0％]，p <0.001）中解释了更大的死亡事件比率，而不是在老年人群体中（PAF：35.3％，95％CI [27.2％，43.4％]，p <0.001）。亚临床血压（PAF：16.9％，95％ CI [14.7％，19.1％]，p <0.001）是最年轻的年龄组中所有因病死亡的主要可归因风险因素，而CKD（PAF：15.2％，95％ CI [14.0％，16.4％]，p <0.001）和CVD（PAF：9.2％，95％ CI [8.3％，10.1％]，p <0.001）则是最年长年龄组的主要可归因风险因素。分析仅限于中国人，可能会影响与不同风险特征的全球人群的一般性。此外，PAFs是在风险因素与死亡之间的因果关系的假设下估计的。然而，在观察性研究中可靠的因果关系很难建立。合并症和可改变的风险因素与2型糖尿病患者的死亡风险在年轻人中存在更大的相对风险，其与人口死亡负担的关系因年龄不同而差异较大。这些发现突显了早期控制血压的重要性，这可以减少年轻人患2型糖尿病的早期死亡，防止年龄增长后患上CKD，并导致相关死亡。 版权所有：© 2023 Wu等人。本文是根据创作共用许可证分发的开放获取文章，允许在任何媒介上无限制使用、分发和再制作，前提是原始作者和来源得到了认可。

The prevalence of type 2 diabetes has increased in both young and old people. We examined age-specific associations and population attributable fractions (PAFs) of risk factors for all-cause and cause-specific mortality in people with type 2 diabetes.We analysed data from 360,202 Chinese with type 2 diabetes who participated in a territory-wide diabetes complication screening programme in Hong Kong between January 2000 and December 2019. We compared the hazard ratios and PAFs of eight risk factors, including three major comorbidities (cardiovascular disease [CVD], chronic kidney disease [CKD], all-site cancer) and five modifiable risk factors (suboptimal HbA1c, suboptimal blood pressure, suboptimal low-density lipoprotein cholesterol, smoking, and suboptimal weight), for mortality across four age groups (18 to 54, 55 to 64, 65 to 74, and ≥75 years). During a median 6.0 years of follow-up, 44,396 people died, with cancer, CVD, and pneumonia being the leading causes of death. Despite a higher absolute mortality risk in older people (crude all-cause mortality rate: 59.7 versus 596.2 per 10,000 person-years in people aged 18 to 54 years versus those aged ≥75 years), the relative risk of all-cause and cause-specific mortality associated with most risk factors was higher in younger than older people, after mutually adjusting for the eight risk factors and other potential confounders including sex, diabetes duration, lipid profile, and medication use. The eight risk factors explained a larger proportion of mortality events in the youngest (PAF: 51.6%, 95% confidence interval [CI] [39.1%, 64.0%], p < 0.001) than the oldest (PAF: 35.3%, 95% CI [27.2%, 43.4%], p < 0.001) age group. Suboptimal blood pressure (PAF: 16.9%, 95% CI [14.7%, 19.1%], p < 0.001) was the leading attributable risk factor for all-cause mortality in the youngest age group, while CKD (PAF: 15.2%, 95% CI [14.0%, 16.4%], p < 0.001) and CVD (PAF: 9.2%, 95% CI [8.3%, 10.1%], p < 0.001) were the leading attributable risk factors in the oldest age group. The analysis was restricted to Chinese, which might affect the generalisability to the global population with differences in risk profiles. Furthermore, PAFs were estimated under the assumption of a causal relationship between risk factors and mortality. However, reliable causality was difficult to establish in the observational study.Major comorbidities and modifiable risk factors were associated with a greater relative risk for mortality in younger than older people with type 2 diabetes and their associations with population mortality burden varied substantially by age. These findings highlight the importance of early control of blood pressure, which could reduce premature mortality in young people with type 2 diabetes and prevent the onset of later CKD and related mortality at older ages.Copyright: © 2023 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.