Mortality Trends in Men and Women with Diabetes, 1971–2000

7 August 2007 | Volume 147 Issue 3

Background: Whether mortality rates among diabetic adults or excess mortality associated with diabetes in the United States has declined in recent decades is not known.

Objective: To examine whether all-cause and cardiovascular disease mortality rates have declined among the U.S. population with and without self-reported diabetes.

Design: Comparison of 3 consecutive, nationally representative cohorts.

Setting: Population-based health surveys (National Health and Nutrition Examination Surveys I, II, and III) with mortality follow-up assessment.

Patients: Survey participants age 35 to 74 years with and without diabetes.

Measurements: Diabetes was determined by self-report for each survey (1971–1975, 1976–1980, and 1988–1994), and mortality rates were determined through 1986, 1992, and 2000 for the 3 surveys, respectively.

Results: Among diabetic men, the all-cause mortality rate decreased by 18.2 annual deaths per 1000 persons (from 42.6 to 24.4 annual deaths per 1000 persons; P = 0.03) between 1971 to 1986 and 1988 to 2000, accompanying decreases in the nondiabetic population. Cardiovascular disease mortality trends paralleled those of all-cause mortality, with 26.4 annual deaths per 1000 persons in 1971 to 1986 and 12.8 annual deaths per 1000 persons in 1988 to 2000 (P = 0.06). Among women with diabetes, however, neither all-cause nor cardiovascular disease mortality declined between 1971 to 1986 and 1988 to 2000, and the all-cause mortality rate difference between diabetic and nondiabetic women more than doubled (from a difference of 8.3 to 18.2 annual deaths per 1000 persons). The reduction in mortality rates among diabetic men eliminated the sex difference in rates among diabetic adults that was observed in earlier surveys.

Limitations: Diabetes was assessed by self-report, and statistical power to examine the factors explaining mortality trends was limited.

Conclusions: Progress in reducing mortality rates among persons with diabetes has been limited to men. Diabetes continues to greatly increase the risk for mortality, particularly among women.

Editors' Notes Context Whether the mortality reductions observed over recent decades in the United States have been similar in the diabetic and nondiabetic populations is unknown. Contribution The 1971–2000 National Health and Nutrition Examination Surveys and vital statistics data reveal higher mortality in the diabetic than in the nondiabetic population. Over this period, diabetic men experienced mortality reductions that paralleled those of nondiabetic men. However, the mortality difference between diabetic and nondiabetic women more than doubled. Implications Mortality among diabetic women does not reflect improvements in the care of diabetes and other cardiovascular risk factors. Understanding the sex differences in diabetes outcomes should be a research priority. —The Editors

 

Author and Article Information

From the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Edward Gregg, PhD, Division of Diabetes Translation (K-10), Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3727.

Current Author Addresses: Drs. Gregg and Cheng: Division of Diabetes Translation (K-10), Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3727.

Dr. Gu: National Center for Health Statistics, Centers for Disease Control and Prevention, Metro IV Building, 3311 Toledo Road, Hyattsville, MD 20782.

Dr. Narayan: The Rollins School of Public Health, Room 730, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322.

Dr. Cowie: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Boulevard, Room 691, Bethesda, MD 20892-5460.

Author Contributions: Conception and design: E.W. Gregg, K.M.V. Narayan.

Analysis and interpretation of the data: E.W. Gregg, Q. Gu, Y.J. Cheng, K.M.V. Narayan, C.C. Cowie.

Drafting of the article: E.W. Gregg.

Critical revision of the article for important intellectual content: E.W. Gregg, Y.J. Cheng, K.M.V. Narayan, C.C. Cowie.

Final approval of the article: E.W. Gregg, Y.J. Cheng, K.M.V. Narayan, C.C. Cowie.

Statistical expertise: Q. Gu.

Obtaining of funding: E.W. Gregg, C.C. Cowie.

Administrative, technical, or logistic support: E.W. Gregg, K.M.V. Narayan.

Collection and assembly of data: Q. Gu, Y.J. Cheng.

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