Death certificate sample

Because of small sample sizes, most population-based and cohort studies of diabetes mortality are unable to examine causes of death less frequent than cardiovascular disease, malignant neoplasms, and diabetes. Therefore, little is known about the excess risk that less frequent causes may convey for persons with diabetes. A diabetes check-box ("Was deceased diabetic?") was added to the North Dakota (ND) death certificate in 1992. We used 1992-1996 North Dakota death certificate and population estimates from the Behavioral Risk Factor Surveillance System to examine the overall and cause-specific risk of death among persons with diabetes relative to persons without diabetes. Between 1992 and 1996, we estimated that 5,326 North Dakota adults with diabetes died, representing 18.5% of all adult deaths in North Dakota. Overall, age-adjusted death rates in the diabetic population were 2.6 times that of the non-diabetic population and were higher for each of the 10 causes of death examined. Age-adjusted death rates were at least twice as high for heart disease (including ischemic heart disease), cerebrovascular disease, accidents/adverse events, and kidney disease. In addition, death rates were 70-80% higher for pneumonia and influenza, malignant neoplasms, arterial disease, and the category of all other causes and 30% higher for chronic obstructive pulmonary disease. In summary, although a large proportion of the deaths are related to cardiovascular disease, North Dakota adults with diabetes are also at increased risk of death from less frequent causes of death. Further studies are needed to investigate the reasons for this increased risk.

EDWARD F. TIERNEY, LINDA S. GEISS, MICHAEL M. ENGELGAU, THEODORE J. THOMPSON, DARIAN SCHAUBERT, LARRY A. SHIRELEY, STEPHEN L. MCDONOUGH, PAMELA J. VUKELIC, Atlanta, GA; Bismark, ND