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Mortality in diabetes mellitus: experience of a geographically defined population
J S Wong1, D W Pearson, L E Murchison
1Diabetic Clinic, Grampian Health Board, Aberdeen, UK.
Insights
Diabetes mellitus increases overall mortality, primarily due to ischemic heart disease. While cancer mortality is reduced in diabetic men, overall cancer death reduction is not significant in women.
Area of Science:
- Epidemiology
- Cardiology
- Oncology
Background:
- Diabetes mellitus is a significant public health concern associated with increased morbidity and mortality.
- Understanding the specific causes of death in diabetic populations is crucial for targeted interventions and improved patient outcomes.
Purpose of the Study:
- To investigate the causes of death in a diabetic population compared to a non-diabetic population.
- To determine the standardized mortality ratio (SMR) for overall mortality and specific causes, including ischemic heart disease and malignant neoplasms.
Main Methods:
- A population-based cohort study was conducted over a 5-year period.
- Data included 4186 patients with diabetes mellitus and identified 915 deaths.
- Standardized mortality ratios (SMR) were calculated and compared between diabetic and non-diabetic groups.
Main Results:
- Diabetic patients exhibited a significantly higher overall mortality (SMR 1.15).
- Ischemic heart disease was a major cause of excess death in diabetics (SMR 1.55), particularly in middle-aged women.
- Cancer mortality was reduced in diabetic men (SMR 0.65) but not significantly in women; stroke mortality showed no significant increase.
Conclusions:
- Diabetes mellitus is associated with increased overall mortality, driven mainly by ischemic heart disease.
- The impact of diabetes on mortality varies by cause and sex, with a notable reduction in cancer mortality observed in men.
- Further research is needed to understand the mechanisms behind reduced cancer mortality in diabetic men and to address disparities in women.
Abstract:
A population-based cohort study identified 915 deaths in 4186 patients with diabetes mellitus over a 5-year period. Ischaemic heart disease, cerebrovascular disease and malignant neoplasms were the major causes of death and accounted for 40%, 16%, and 14% of deaths, respectively, compared with 27%, 14%, and 25% of deaths in the non-diabetic population. Diabetic patients had a standardized mortality ratio (SMR) of 1.15 (95% Cl 1.08-1.22) (p less than 0.001). This excess risk of death was largely due to the excess death from ischaemic heart disease (SMR 1.55 (1.40-1.71); p less than 0.001) and the impact was greatest in middle-aged female patients. Stroke mortality was not significantly increased (SMR 1.09 (0.92-1.29)) while cancer mortality was reduced (SMR 0.75 (0.63-0.89); p less than 0.01). Death rates in diabetic male patients (SMR 1.04 (0.96-1.13)) did not differ significantly from those in non-diabetic male patients because the increased risk of ischaemic heart disease deaths (SMR 1.41 (1.22-1.62); p less than 0.001) was offset by the reduced risk of deaths from malignant neoplasms (SMR 0.65 (0.51-0.82); p less than 0.001). The reduction in cancer mortality did not reach statistical significance in diabetic women (SMR 0.82 (0.64-1.05)). Diabetic nephropathy and metabolic disasters were uncommon as causes of death.