Mortality in Israeli Jewish patients with Type 1 (insulin-dependent) diabetes mellitus diagnosed prior to 18 years of age: a population based study

Abstract

A total of 614 Jewish patients under the age of 18 with Type 1 (insulin-dependent) diabetes mellitus, diagnosed in Israel during the period 1 January 1965 to 31 December 1979, were identified by exhaustive screening of all possible sources. Mortality experience of this cohort was updated to 31 March 1988 through the Central Population Registry and 14 deaths were identified. The ascertainment rate for diagnosed cases as well as for deaths is estimated at about 95%. There was a significantly higher (p less than 0.001) by 3.2-fold excess mortality relative to the age and sex-adjusted mortality as expected the general Jewish population in Israel. This excess was due to three cause-of-death categories: diabetic ketoacidosis (n = 3; p less than 0.001), cardiovascular diseases (n = 3; p less than 0.001) and infections (n = 2; p = 0.03). The rate of malignancies (n = 2), external causes (n = 3) and other general causes (n = 1) did not differ significantly from that expected. During the first 15 years of the disease cumulative mortality resembled that of the general population, with a subsequent steep increase so that by 20 years disease duration, the rate was four-fold higher than expected. This mortality pattern was similar irrespective of age at onset, sex and ethnic group (Ashkenazi vs non-Ashkenazi Jews). A factor contributing to the lack of increase in mortality rate in the first 15 years of Type 1 diabetes may be the comprehensive multidisciplinary treatment approach employed for most juvenile diabetic patients in Israel leading to early referral and an overall better metabolic control.

The 30-Year Natural History of Type 1 Diabetes Complications

“…The dramatic decrease over time in the cumulative incidence of mortality and renal failure is consistent with two reports from our Allegheny County registry: a community-based population of childhood-onset type 1 diabetes (5,6) and an Israeli mortality study (26). The explanation for the improved mortality is likely to be multifaceted, but because our data show only a modest decrease in the underlying complications that lead to death (overt nephropathy and CAD), improved management of complications, as well as decreased incidence, are likely to contribute.…”

The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality

“…We found the highest obs/exp ratios in younger subjects, most of whom were IDDM patients. Even though our absolute values were somewhat different from those reported by others [17,24,25,[35][36][37], the phenomenon we observed was similar to that described by these authors. However, it should be mentioned that in young age groups the evaluation of mortality risk is hampered by the generally low number of observed and expected deaths.…”

Neighborhood Socioeconomic Context and Long-Term Survival After Myocardial Infarction

“…The Israeli Population Registry has complete ascertainment of death. 31 The primary study end points were all-cause and cardiac mortality. The latter was defined as death caused by coronary heart disease or other diseases of the heart.…”