Posted May 1 , 2017 12:57 PM

Deaths Attributable to Diabetes in the United States: Comparison of Data Sources and Estimation Approaches

Stokes A, and Preston SH. PLOSone 2017,12(1): e0170219

What were the findings (excerpted from the Abstract)?

The goal of this research was to identify the fraction of deaths attributable to diabetes in the United States. The authors estimated population attributable fractions (PAF) for cohorts aged 30–84 who were surveyed in the National Health Interview Survey (NHIS) between 1997 and 2009 (N = 282,322) and in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010 (N = 21,814). Cohort members were followed prospectively for mortality through 2011. Diabetes status was identified using self-reported diagnoses in both NHIS and NHANES and using HbA1c in NHANES. Hazard ratios associated with diabetes were estimated using Cox model adjusted for age, sex, race/ethnicity, educational attainment, and smoking status. They found a high degree of consistency between data sets and definitions of diabetes in the hazard ratios, estimates of diabetes prevalence, and estimates of the proportion of deaths attributable to diabetes. The proportion of deaths attributable to diabetes was estimated to be 11.5% using self-reports in NHIS, 11.7% using self-reports in NHANES, and 11.8% using HbA1c in NHANES. Among the sub-groups that we examined, the PAF was highest among obese persons at 19.4%. The proportion of deaths in which diabetes was assigned as the underlying cause of death (3.3–3.7%) severely understated the contribution of diabetes to mortality in the United States.

Why is this important?

While we all know that diabetes can have many different complications and some are even treatable, we often don’t appreciate that in their sum total, diabetes and its complications are often lethal, shortening the life of an individual with type 2 diabetes by roughly 8.5 years for a person diagnosed at age 50. ( This results in diabetes being labeled the 3rd leading cause of death in the US. It represents a more prominent factor in American mortality than is commonly appreciated, reinforcing the need for robust population-level interventions aimed at diabetes prevention and care. This article brings these statistics into sharp focus and should always be an underlying stimulus to do better in treating diabetes and its complications to recommended guideline endpoints. (Standards of Medical Care in Diabetes. Diabetes Care 2017;40[suppl1]). Were you aware of the death rate from diabetes? Do your patients ever ask you about it?

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