Trends in overall, cardiovascular and cancer-related mortality among individuals with diabetes reported on death certificates in the United States between 2007 and 2017
The determination of diabetes as underlying cause of death by using the death certificate may result in inaccurate estimation of national mortality attributed to diabetes, because individuals who die with diabetes generally have other conditions that may contribute to their death. We investigated the trends in age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality from cardiovascular disease (CVD), complications of diabetes and cancer among individuals with diabetes listed on death certificates in the USA from 2007 to 2017.
Using the US Census and national mortality database, we calculated age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality rates among adults over 20 years with diabetes listed on death certificates. A total of 2,686,590 deaths where diabetes was underlying or contributing cause of death were analysed. We determined temporal mortality rate patterns by joinpoint regression analysis with estimates of annual percentage change (APC).
Age-standardised diabetes mortality rates compared among underlying cause of death, contributing cause of death and all-cause mortality were 32.2 vs 75.7 vs 105.1 per 100,000 individuals during the study period. The age-standardised mortality rates due to diabetes as underlying or contributing cause of death declined from 112.2 per 100,000 individuals in 2007 to 104.3 per 100,000 individuals in 2017 with the most pronounced decline noted from 2007 to 2014 (APC −1.4%; 95% CI −1.9%, −1.0%) and stabilisation in decline from 2014 to 2017 (APC 1.1%; 95% CI −0.6%, 2.8%). In terms of cause-specific mortality among individuals with diabetes listed on death certificates, the age-standardised mortality rates for CVD declined at an annual rate of 1.2% with a marked decline of 2.3% between 2007 and 2014. Age-standardised diabetes-specific mortality rates as underlying cause of death decreased from 2007 to 2009 (APC −4.5%) and remained stable from 2009 to 2017. Age-standardised mortality rates for cancer steadily decreased with an average APC of −1.4% (95% CI −1.8%, −1.0%) during the 11-year period. Mortality in the subcategory of CVD demonstrated significant differences.
Current national estimates capture about 30% of all-cause mortality among individuals with diabetes listed as underlying or contributing cause of death on death certificates. The age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality from CVD in individuals with diabetes listed as underlying or contributing cause of death plateaued from 2014 onwards except for hypertensive heart disease and heart failure.
KeywordsCancer Cardiovascular disease Complication Epidemiology Mortality
Annual percentage change
Hypertensive heart disease
Ischaemic heart disease
National Health Interview Survey
National Vital Statistics System
DK was responsible for study concept and design, acquisition of data, statistical analysis, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and approval of the final draft manuscript. AAL, GC, SHK, EI, JWK and RAH were responsible for study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content and statistical analysis, and approval of the final draft manuscript. AA was responsible for study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, approval of final draft manuscript and supervision of the research project. AA is responsible for the integrity of the work as a whole.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. JWK was supported by the National Institutes of Health, USA (P30DK116074, U41HG009649, 1R01DK107437).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
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