Tracking three decades of type 1 diabetes‐related chronic kidney disease in East Asia: Burden, age–sex patterns, and quality of care index

BACKGROUND: The escalating burden of type 1 diabetes-related chronic kidney disease (CKD-T1DM) presents a critical public health challenge worldwide. This study aims to comprehensively evaluate the longitudinal trends in disease burden and healthcare quality for CKD-T1DM in East Asia compared with global patterns from 1990 to 2023. METHODS: Utilizing data from the Global Burden of Disease (GBD) Study 2023, we analyzed the age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) rates of CKD-T1DM. The Estimated Annual Percentage Change (EAPC) was calculated to quantify temporal trends. Additionally, a multidimensional quality of care index (QCI) was constructed using principal component analysis (PCA) based on four proxy indicators to assess and benchmark healthcare performance across East Asian countries. RESULTS: Contrary to the global trend of rising mortality and disability burdens, East Asia exhibited a significant concurrent decline in ASIR, ASMR, and ASDR from 1990 to 2023. However, substantial regional heterogeneity was observed: Japan and South Korea maintained consistently high QCI scores (63.8-75.0), while China, Mongolia, and North Korea lagged significantly behind. The study also confirmed a bimodal age-specific incidence pattern peaking in adolescence (10-14 years) and older adulthood (55-69 years), alongside notable gender disparities in older populations. CONCLUSION: East Asia has achieved remarkable progress in mitigating the CKD-T1DM burden, diverging significantly from the global trajectory; however, deep structural inequities in care quality persist between high-income and middle-to-low-income nations. Integrating QCI into national monitoring systems and prioritizing comprehensive, lifespan-oriented management strategies are essential to addressing these disparities and sustaining regional improvements.