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 United States and worldwide in the last
The proportion of deaths attributable to diabetes in the U.S. is as
high as 12% - three times higher than estimates based on death
certificates suggest, according to a new analysis led by a Boston
University School of Public Health (BUSPH) researcher.
‘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’
The study, published in the journal PLOS ONE
, used two large
data sets that included more than 300,000 people to estimate the
fraction of deaths attributable to diabetes among individuals ages 30 to
84 between 1997 and 2011. To come up with the estimates, the
researchers calculated the prevalence of diabetes in the population, as
well as excess mortality risk among people with diabetes over five years
of follow up.
The proportion of deaths attributable to diabetes was estimated to be
11.5% using one dataset - the National Health Interview Study
(NHIS) - and 11.7% using the other, 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 is 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 Andrew Stokes, assistant professor of
global health at BUSPH, and co-author Samuel Preston, professor of
sociology and a researcher with the Population Studies Center at the
University of Pennsylvania.
They said their analysis indicates that diabetes was the third
leading cause of death in the U.S. in 2010, after diseases of the heart
and malignant neoplasms.
"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,"
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 are mentioned on a death
certificate, the researchers added, the decision about whether diabetes
is listed as the underlying cause is "highly variable."
The NHIS data set is based on self-reports of diabetes diagnoses,
while the NHANES data contains both self-reports and HbA1c 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 over five years.