Study: U.S. Deaths From Diabetes Significantly Underestimated

Actual rate is three times higher than death certificates suggest, authors find

The proportion of deaths attributable to diabetes in the Unites States is as high as 12%––three times higher than estimates based on death certificates have suggested, according to a new analysis led by a researcher at the Boston University School of Public Health.

The study, published in PLOS One, used two large data sets that included more than 300,000 people to estimate the proportion of deaths attributable to diabetes among individuals 30 to 84 years of age between 1997 and 2011. The researchers calculated the prevalence of diabetes in this population, as well as the excess mortality risk among people with diabetes during five years of follow-up.

The proportion of deaths attributable to diabetes was estimated to be 11.5% using one data set (the National Health Interview Study [NHIS]) and 11.7% using the other data set (the National Health and Nutrition Examination Survey [NHANES]). Among the subgroups examined, the attributable fraction was highest among individuals with obesity (19.4%).

The proportion of deaths overall was significantly higher than the 3.3% to 3.7% of deaths in which diabetes was identified on death certificates as the underlying cause.

“The frequency with which diabetes is listed as the underlying cause of death is not a reliable indicator of its actual contribution to the national mortality profile,” wrote co-authors Dr. Andrew Stokes and Dr. Samuel Preston.

They said their analysis indicated that diabetes was the third leading cause of death in the U.S. in 2010, after diseases of the heart and malignant neoplasms.

Diabetes is associated with a number of diseases and disabilities, including ischemic heart disease, renal disease, and visual impairment. Its prevalence has risen rapidly in the U.S. during the past 20 years.

“Our results demonstrate that diabetes is a major feature on the landscape of American mortality, and they reinforce the need for robust population-level interventions aimed at diabetes prevention and care,” Stokes said.

The study noted that “the sensitivity and specificity of death certificate assignments of diabetes as an underlying cause of death are low––far below those of administrative records or surveys.” When both diabetes and heart disease were mentioned on a death certificate, the researchers added, the decision about whether diabetes was listed as the underlying cause was “highly variable.”

The NHIS data set is based on self-reports of diabetes diagnoses, whereas the NHANES data include both self-reports and hemoglobin A1C levels, a preferred biomarker for the presence of diabetes. Individuals in both data sets were linked to the National Death Index through December 2011 to calculate mortality during a five-year period.

Source: EurekAlert; January 26, 2017.