Related Experiment Video
Updated: Apr 5, 2026
Protocol to Create Chronic Wounds in Diabetic Mice
Published on: September 25, 2019
Multiple causes of death analysis of chronic diseases: the example of diabetes
Ugo Fedeli1, Giacomo Zoppini2, Carlo Alberto Goldoni3
1Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, Padova (PD), 35131 Italy.
Insights
Multiple causes of death (MCOD) analysis for diabetes reveals higher mortality rates and provides richer insights than single underlying cause of death (UCOD) data. This approach enhances understanding of chronic disease associations.
Area of Science:
- Epidemiology
- Public Health
- Medical Statistics
Background:
- The single underlying cause of death (UCOD) approach simplifies complex mortality pathways.
- The multiple causes of death (MCOD) method considers all mentioned diseases on death certificates.
- Diabetes serves as a model to investigate MCOD's utility in understanding mortality patterns and chronic disease associations.
Purpose of the Study:
- To evaluate death certification patterns for diabetes using both UCOD and MCOD.
- To compare mortality figures derived from UCOD versus MCOD for diabetes.
- To identify factors influencing the mention of diabetes on death certificates and explore MCOD's potential in analyzing chronic disease associations.
Main Methods:
- Analysis of the Veneto Region's mortality archive (2008-2010).
- Calculation of mortality and proportional mortality rates for diabetes under UCOD and MCOD.
- Logistic regression to assess associations between diabetes, chronic liver diseases (CLD), and other comorbidities using a subset of known diabetic patients.
Main Results:
- Diabetes was mentioned in 12.3% of death certificates and as UCOD in 2.9%.
- MCOD revealed significantly higher mortality rates for diabetes (112.6×10^5) compared to UCOD (26.8×10^5).
- In known diabetic patients, diabetes was reported in 52.1% (MCOD) versus 13.4% (UCOD), with reporting influenced by comorbidities like circulatory diseases, renal failure, and neoplasms.
Conclusions:
- MCOD analysis, while more complex, offers a more comprehensive understanding of mortality data compared to UCOD.
- The study highlights inconsistencies in death certification, particularly regarding diabetes's role as a consequence of other diseases.
- MCOD is valuable for analyzing the complex interplay between chronic diseases and mortality.
Background:
Identifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases.
Methods:
The whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.
Results:
In the whole mortality archive, diabetes was mentioned in 12.3 % of death certificates, and selected as the UCOD in 2.9 %. The death rate for diabetes as the UCOD was 26.8 × 10(5) against 112.6 × 10(5) for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1 %, and selected as the UCOD in 13.4 %. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm.
Conclusions:
The use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.
Related Concept Videos
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:30Coronary Artery Disease I: Introduction
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:19Psychoneuroimmunology: Diabetes and Cancer
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:25Chronic Kidney Disease I: Introduction