{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:00:31Z","timestamp":1774267231526,"version":"3.50.1"},"reference-count":76,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":70,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011827","name":"Guangxi Medical University","doi-asserted-by":"publisher","award":["GXMUYSF202445"],"award-info":[{"award-number":["GXMUYSF202445"]}],"id":[{"id":"10.13039\/501100011827","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) has emerged as a pressing global health challenge, and tobacco exposure constitutes a major modifiable risk factor\u2014particularly among middle\u2010aged and elderly populations. However, a comprehensive understanding of the global burden of tobacco exposure\u2013attributable mortality and disability\u2010adjusted life years (DALYs) in this demographic remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study is aimed at quantifying the global burden of deaths and DALYs attributable to tobacco exposure among middle\u2010aged and elderly individuals with T2DM from 1990 to 2021. Simultaneously, this study assesses disparities across regions, genders, and age groups; examines associations with the sociodemographic index (SDI); and forecasts trends in disease burden from 2022 to 2042.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Utilizing data from the Global Burden of Disease (GBD) 2021 study, which encompasses 204 countries and territories, we assessed burden counts and rates per 100,000 population among individuals aged 55 years and older. We further computed the estimated annual percentage changes (EAPCs) and applied age\u2013period\u2013cohort (APC) modeling, frontier analysis, and Bayesian age\u2013period\u2013cohort (BAPC) forecasting models to enable comprehensive analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, tobacco exposure\u2013attributable T2DM deaths increased by 101.10%, and DALYs rose by 140.38%, though the mortality rate decreased by 9.13%. Regions with middle and low\u2013middle SDI shouldered the highest burden of tobacco\u2010attributable T2DM. High\u2010SDI regions demonstrated the most substantial declines in burden rates, whereas low\u2013middle\u2010SDI regions experienced the largest relative increases. Males exhibited greater mortality and DALYs counts compared to females, while females showed more pronounced reductions in burden trends. APC modeling further indicated that advancing age correlated with elevated risks of tobacco exposure\u2013attributable T2DM outcomes, whereas younger birth cohorts showed lower risks. Frontier analysis identified middle\u2010SDI countries (e.g., Kiribati) as exhibiting the greatest deviation from optimal performance. Projections through 2042 indicate that the mortality rate is projected to continue declining: It will reach 9.25 per 100,000 aged \u2265\u200955 population in 2030 (95% CI: 8.64\u20139.85) and 8.57 per 100,000 aged \u2265\u200955 population in 2042 (95% CI: 6.89\u201310.24).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tobacco exposure\u2013attributable T2DM burden demonstrates marked variations across geographic regions, sex, and age groups, highlighting the imperative for targeted interventions in low\u2013middle\u2010SDI regions. Tobacco control strategies from high\u2010SDI regions serve as scalable models for mitigating this preventable disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jdr\/5522115","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T08:32:24Z","timestamp":1773304344000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Global Mortality and Disability\u2010Adjusted Life Years Attributable to Tobacco Exposure Among Middle\u2010Aged and Older Adults With Type 2 Diabetes, 1990\u20132021: A Systematic Analysis of GBD 2021 Data With Projections to 2042"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2713-6106","authenticated-orcid":false,"given":"Yujun","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6711-4171","authenticated-orcid":false,"given":"Minhui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0770-7083","authenticated-orcid":false,"given":"Bowen","family":"Xing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1445-3013","authenticated-orcid":false,"given":"Hui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8811-8692","authenticated-orcid":false,"given":"Jiujie","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2272-7061","authenticated-orcid":false,"given":"Wei","family":"Mai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8177-3782","authenticated-orcid":false,"given":"Simin","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0499-1548","authenticated-orcid":false,"given":"Zhenyi","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4403-1324","authenticated-orcid":false,"given":"Xiaoyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7402-0998","authenticated-orcid":false,"given":"Yi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9557-0446","authenticated-orcid":false,"given":"Yuping","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00198"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1501690"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X1604201229115531"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2021.174410"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12081882"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-90437-x"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.4213"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1506749"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16471"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.12326"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00038-3"},{"key":"e_1_2_13_13_2","volume-title":"The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001","author":"Mathers C. 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