Mortality trends in men and women with diabetes, 1971 to 2000

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

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

Comparison of 3 consecutive, nationally representative cohorts.

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

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

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.

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. Trends for cardiovascular disease mortality 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 difference in all-cause mortality rates by sex among people with diabetes in 1971 to 1986 were essentially eliminated in 1988 to 2000.

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

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