Mortality from diabetic renal disease: a hidden epidemic

Area of Science:

• Public Health
• Epidemiology
• Biostatistics

Background:

• Population-level mortality indicators are crucial for assessing diabetes care outcomes.
• Death registration systems are primary data sources, but standard methods inadequately capture diabetic renal disease burden.
• Underlying cause of death coding may not fully represent mortality from diabetes complications.

Purpose of the Study:

• To analyze multiple causes of death data to better estimate mortality from diabetic renal disease.
• To compare underlying cause mortality rates with multiple cause mortality rates for diabetic renal disease.
• To identify discrepancies in diabetes mortality statistics between Australia and the USA.

Main Methods:

• Analysis of death registration data from Australia and the USA, focusing on multiple causes of death.
• Application of automated coding systems to select underlying causes of death according to International Classification of Diseases (ICD).
• Calculation of age-standardized mortality rates for 'diabetes with renal complications' and comparison with rates derived from additional deaths listing diabetes and renal failure.

Main Results:

• Current automated coding assigns three-fourths of diabetes deaths to 'diabetes without complications,' irrespective of listed contributing factors.
• Estimated multiple cause death rates for diabetic renal disease are 4 to 9 times higher than underlying cause rates.
• Multiple cause death rates for diabetic renal disease show an increasing trend, unlike underlying cause rates.

Conclusions:

• Routine underlying cause statistics significantly underestimate mortality from diabetic renal disease in the USA and Australia.
• There is a critical need for revised guidelines on certifying, coding, and statistically presenting diabetes mortality data.
• Improved statistical reporting is essential for accurate epidemiology and effective health policy development for diabetes.