Reliability of causes of death in persons with Type I diabetes

Mühlhauser, Ingrid; Pt, Sawicki; Blank, Melanie; Overmann, H.; Richter, Bernd; Berger, Michael

doi:10.1007/s00125-002-0957-8

Cited by 47 publications

(11 citation statements)

References 14 publications

(19 reference statements)

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“…Nevertheless, our data are consistent with other reports showing a lower prevalence of coronary artery calcification, a subclinical marker of atherosclerosis, in Blacks than in Whites 28. Limitations of ascertaining causes of death from data collected from death certificates in individuals with diabetes have been reported 5,29. Ischaemic heart disease has been reported to be over-represented as a cause of death on death certificates compared with physician-confirmed causes of death 30, but unless this over-reporting of ischaemic heart disease on death certificates differentially affects White and Black people, this would not have affected our primary results.…”

Section: Discussionsupporting

confidence: 91%

Cause‐specific mortality by race in low‐income Black and White people with Type 2 diabetes

et al. 2014

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AimTo investigate, with extended follow-up, cause-specific mortality among low-income Black and White Americans with Type 2 diabetes who have similar socio-economic status.MethodsBlack and White Americans aged 40–79 years with Type 2 diabetes (n = 12 498) were recruited from community health centres as part of the Southern Community Cohort Study. Multivariable Cox analysis was used to estimate mortality hazard ratios and 95% CIs for subsequent cause-specific mortality, based on both underlying and contributing causes of death.ResultsDuring the follow-up (median 5.9 years), 13.3% of the study population died. The leading causes of death in each race were ischaemic heart disease, respiratory disorders, cancer, renal failure and heart failure; however, Blacks were at a lower risk of dying from ischaemic heart disease (hazard ratio 0.70, 95% CI 0.54–0.91) or respiratory disorders (hazard ratio 0.70, 0.53–0.92) than Whites but had higher or similar mortality attributable to renal failure (hazard ratio 1.57, 95% CI 1.02–2.40), heart failure (hazard ratio 1.47, 95% CI 0.98–2.19) and cancer (hazard ratio 0.87, 95% CI 0.62–1.22). Risk factors for each cause of death were generally similar in each race.ConclusionsThese findings suggest that the leading causes of death and their risk factors are largely similar among Black and White Americans with diabetes. For the two leading causes of death in each race, however, ischaemic heart disease and respiratory disorders, the magnitude of risk is lower among Black Americans and contributes to their higher survival rates.

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Section: Discussionsupporting

confidence: 91%

Cause‐specific mortality by race in low‐income Black and White people with Type 2 diabetes

et al. 2014

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“…This 11-year retrospective audit directly defines the precise causes of death in DFU patients. Postmortem results were examined to avoid inaccuracies as can occur with death certification [ 9 ]. The results confirmed IHD as the major cause of death in DFU patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

Chammas

Hill²,

Edmonds

2016

Journal of Diabetes Research

126

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Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.

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“…Nevertheless, we believe our data are applicable to middle-aged individuals from low SES communities with long duration of young-onset diabetes where clinical features of both type 1 and type 2 diabetes may overlap. Finally, limitations regarding the use of death certificate data have been well described (7,20,38), and the presence of multiple end-organ complications is common in individuals with longstanding diabetes (39); for example, CAD is rare in the absence of underlying renal disease in individuals with young-onset diabetes, particularly type 1 (40). Thus, data relying only on the underlying causes of death listed on death certificates may substantially underestimate the impact of diabetes-related complications on total mortality in individuals with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Mortality Experience of a Low-Income Population With Young-Onset Diabetes

et al. 2012

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OBJECTIVEIn young-onset diabetes, insulin therapy status is a rough marker of diabetes type. We describe the mortality experience of a low-income, predominantly minority population with diabetes diagnosed before age 30 years, stratified by insulin therapy.RESEARCH DESIGN AND METHODSA total of 1,098 adults aged 40–79 years (median 49) diagnosed with diabetes before age 30 years and 49,914 without diabetes were recruited from community health centers. Individuals with diabetes were categorized by insulin therapy at baseline: group A, insulin therapy only; group B, insulin therapy and an oral hypoglycemic agent; and group C, no insulin therapy. Cox models were used to compute hazard ratios (HRs) and 95% CI for cause-specific mortality based on both underlying and contributing causes of death from death certificates.RESULTSDuring follow-up (mean 3.9 years), 15.0, 12.5, and 7.3% of groups A, B, and C, respectively, and 4.6% without diabetes died. Compared with individuals without diabetes, HRs (CI) for all-cause mortality were 4.3 (3.4–5.6), 4.2 (2.8–6.3), and 2.0 (1.4–2.8) in groups A, B, and C, respectively. The leading cause of death was renal failure (end-stage renal disease [ESRD]) in group A, ESRD and coronary artery disease (CAD) in group B, and CAD in group C and individuals without diabetes. HRs for these conditions were at least twice as high as the HRs for all-cause mortality, reaching 17.3 (10.2–29.3), 17.9 (8.3–38.7), and 5.1 (2.3–11.7) in groups A, B, and C, respectively, for ESRD.CONCLUSIONSExcess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality.

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Reliability of causes of death in persons with Type I diabetes

Cited by 47 publications

References 14 publications

Cause‐specific mortality by race in low‐income Black and White people with Type 2 diabetes

Cause‐specific mortality by race in low‐income Black and White people with Type 2 diabetes

Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

Mortality Experience of a Low-Income Population With Young-Onset Diabetes

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