Relationship between diabetes and mortality: a population study using record linkage.

Abstract

A population study using record linkage O R I G I N A L A R T I C L EOBJECTIVE -To determine patterns and causes of mortality for patients with diabetes in a district health authority.RESEARCH DESIGN AND METHODS -The study used cross-sectional record linkage, combining an electronic death register with a diabetic patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all diabetic deaths between 1993 and 1996.RESULTS -Of 1,694 deaths in patients with known diabetes, only 674 (39.8%) had diabetes recorded as an immediate or antecedent cause of death. Mortality rates were 41.8 per 1,000 for the diabetic population and 10.1 per 1,000 for the nondiabetic population. The standard mean ratio for the diabetic population was 1.24 (95% CI 1.12-1.35), with the risk of mortality relative to the nondiabetic population decreasing with age. Males with diabetes lost an average of 7.0 years from the year of diagnosis, and females with diabetes lost an average of 7.5 years. The most common cause of death was cardiovascular disease, which accounted for 49.1% of deaths in the diabetic population.CONCLUSIONS -Diabetes is recorded as a cause of death on a minority of death certificates for patients with diabetes. Using death certificates in isolation, therefore, is a poor method of estimating diabetic mortality, but results can be improved with the use of record linkage techniques. Patients with diabetes have an excess risk of mortality compared with the nondiabetic population. Life-years lost for patients with diabetes is strongly related to age at diagnosis and is a means of expressing mortality without relying on accurate prevalence data.

Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: A prospective population-based study in The Netherlands (ZODIAC-1)

“…As compared to international data, we find a higher mortality rate (47.9/1000) than in the UK (41.8/1000) [43]. In the US mortality rates for the population aged >65 years are comparable to ours [44].…”

Life years lost associated with diabetes: An individually matched cohort study using the U.S. National Health Interview Survey data

“…Combining data from 97 prospective studies, the Emerging Risk Factors Collaboration reported an average of 6 year reduction for a 50-year old with diabetes than a counterpart without diabetes [11]. Morgan et al also reported that life-years lost to diabetes strongly decreased with increasing age at diagnosis [22], and such a trend has been consistent in all reports based on the NHIS data [2,3] including ours.…”

“…Some previous studies of other populations also estimated life-years lost associated with diabetes [11,[21][22][23]. Using data from the Framingham Heart Study, Franco et al estimated that men and women 50 years and older with diabetes lived on average 7.5 and 8.2 years less than their equivalents with diabetes, respectively [21].…”

How much does screening bring forward the diagnosis of type 2 diabetes and reduce complications? Twelve year follow-up of the Ely cohort

“…An examination of the mortality experience of the same cohort [40] did suggest that individuals who were invited to screening had a nonsignificant 21% lower mortality (HR 0.79, 95% CI 0.63, 1.00; p00.05) than individuals who were not invited to screening between 1990 and 1999. However, there were relatively few deaths with diabetes noted as an underlying cause (6%); and, although this does not exclude the possibility of coding errors [41], mortality is unlikely to account for the lack of differences between the cases from the screened and unscreened populations.…”