Study: Diabetes Mortality Rates Underestimated
A current study investigated the fraction of deaths related to diabetes and found that the rates have risen significantly since the 1980s. In addition, researchers found that diabetes-related deaths are underrepresented in national health statistics and on death certificates.
According to researchers, diabetes was listed as the underlying cause of death on 2.8% of death certificates, but reports and frequency vary widely. Therefore, this is not a reliable indicator for the national mortality profile. Likewise, the last study to examine diabetes mortality used data from between 1976 and 1980. The population attributable fraction (PAF) for diagnosed diabetes deaths during that study was 3.6%, and rose to 5.1% when undiagnosed diabetes was included in the analysis. Since then, diabetes prevalence has increased significantly.
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The new study sought to determine any changes in diabetes mortality for individuals aged 30 to 84 years from 1997 to 2011. Researchers used the NHANES and the National Health Interview Survey (NHIS) to calculate the current PAF, which combined the excess morality risk with the prevalence of diabetes deaths to determine the fraction of deaths that would not have occurred in the absence of diabetes.
For the study, data from 282,322 individuals were selected from NHIS and 21,814 from NHANES. Cox models and hazard ratios were used and adjusted for sex, age, race and ethnicity, education level, and smoking status. In addition, researchers performed a sensitivity analysis adjustment for body mass index (BMI) to identify individuals with obesity who were at risk of diabetes-related mortality.
Estimates using self-reports from NHIS and NHANES showed that 11.5% and 11.7% of deaths were attributable to diabetes, respectively. When using the HbA1C as a measure of diabetes in the data from NHANES, the proportion of deaths attributable to diabetes was 11.8%.
PAF was the highest for obese individuals and was calculated as 19.4%. Women had a higher PAF (12.9%) than men (11.0%).
The inclusion of prediabetes increased the proportion of deaths attributable to diabetes by an additional 2%.
“For the nation as a whole, only 3.3% of deaths in these cohorts were assigned to diabetes as the underlying cause. However, when deaths were added in which diabetes was mentioned on the death certificate elsewhere than as the underlying cause of death, the proportion rose to 10.8%, similar to the PAF value,” the researchers wrote.
Their findings showed that diabetes is associated with about 12% of deaths in the United States, making it the third leading cause of death in 2010, after cardiovascular disease and cancer.
“These results demonstrate that diabetes is a major feature on the landscape of American mortality and reinforce the need for robust population-level interventions aimed at diabetes prevention and care,” the researchers concluded.
—Melissa Weiss
Reference:
Stokes A, Preston SH. Deaths Attributable to Diabetes in the United States: comparison of data sources and estimation of approaches [published online January 25, 2017]. PLoS One. doi: 10.1371/journal.pone.0170219.