不同肥胖程度下台灣第二型糖尿病死亡率之當前與未來趨勢

Trends and projections of type 2 diabetes mortality under various obesity scenarios in Taiwan

目標：第二型糖尿病（T2DM）為全球主要健康威脅，高身體質量指數（BMI）為其關鍵危險因子。本研究旨在探討不同過重及肥胖情境下，台灣T2DM死亡率之未來趨勢與政策應對建議。方法：本研究採用全球疾病負擔研究（GBD）之比較風險評估法（CRA），分析2001-2020年BMI與死亡資料，估算2021-2035年間T2DM死亡中BMI之可歸因分率（PAF）與不可歸因死亡率，並參考NAHSIT模擬四種過重與肥胖情境。資料來源包括衛生福利部死因登錄檔（T2DM死亡資料）、國民健康訪問調查（NHIS）五次調查之BMI盛行率，以及內政部人口統計資料。相對風險（RR）與理論最小風險暴露水準（TMREL）取自GBD 2021。分析納入三種非歸因死亡率模型進行敏感性分析，並以蒙地卡羅模擬進行不確定性評估。結果：2021年起T2DM粗死亡率上升，年齡標準化率持續下降。歷史資料顯示，男性與女性BMI歸因分率分別為26-30%與25-28%。若未來過重及肥胖率降至32.7%，可避免約15,821人死亡；降至43.3%則約8,787人；若穩定於50%，可避免4,130人。男性與年長者死亡率均相對較高。結論：控制過重與肥胖為減少未來T2DM死亡之關鍵。為有效降低總體死亡負擔，應搭配涵蓋非肥胖相關因素之多元公共衛生策略。本研究可作為未來肥胖管理與糖尿病政策規劃之依據。

Objectives: Type 2 diabetes mellitus (T2DM) is a major global health concern, with high body mass index (BMI) as a key mortality risk factor. This study aimed to estimate current and projected future T2DM mortality trends in Taiwan under various overweight and obesity scenarios. Methods: This study applied the Comparative Risk Assessment (CRA) methodology developed by the Global Burden of Disease Study (GBD). Data from 2001 to 2020 were used to estimate population attributable fractions (PAFs) and non-attributable T2DM mortality burden for 2021-2035. Projections incorporated national mortality records from Taiwan’s National Death Registry, BMI prevalence from five waves of the National Health Interview Survey (NHIS), population data from the Ministry of the Interior, and relative risks and theoretical minimum risk exposure levels (TMRELs) from GBD 2021. Mortality projections incorporated four overweight and obesity scenarios (Current Trend, Stop Rise, Aggressive Intervention 1, and Aggressive Intervention 2, adapted from the Nutrition and Health Survey in Taiwan) and three non-attributable death rate models, with sensitivity and uncertainty analyses conducted using Monte Carlo simulations. Results: Crude T2DM mortality is projected to rise after 2021, while age-standardized rates continue to decline, highlighting the impact of population aging. Between 2001 and 2020, high BMI contributed to 26-30% of T2DM deaths in males and 25-28% in females. Reducing overweight and obesity prevalence to 32.7% could prevent an estimated 15,821 deaths from 2021 to 2035; reducing it to 43.3% could prevent 8,787 deaths; stabilizing it at 50% could prevent 4,130 deaths. Mortality was consistently higher among older adults and males. Conclusions: Aggressive and sustained obesity reduction is essential for curbing future T2DM mortality in Taiwan. However, broader public health strategies addressing both obesity-related and non-obesity-related factors are necessary to substantially reduce the mortality burden.