Trends in mortality due to diabetes in Brazil, 1996-2011

Over recent decades, Brazilian mortality registration has undergone increasing improvement in terms of completeness and quality in cause of death reporting. These improvements, however, complicate the description of mortality trends over this period. We aim to characterize the trend in diabetes mortality in Brazil and its five regions in adults (30-69 years), from 1996 to 2011 after corrections for underreporting of deaths and redistribution of ill-defined causes and "garbage codes".

Starting with official data from the Brazilian Mortality Information System (SIM) for adults aged 30-69 in the period 1996 to 2011 for diabetes (ICD-10 codes E10-14), we redistributed garbage codes using methods based on the Global Burden of Disease Study (2010), redistributed ill-defined causes based on recent Brazilian investigations of similar cases and corrected for underreporting using official estimates of deaths.

With these corrections, age-standardized mortality fell approximately 1.1 %/year for men and 2.2 %/year for women from 1996 to 2011. The rate of decline first accelerated and then decelerated, reaching stable rates in men and minimal declines in women from 2005 onward. Regional inequalities decreased during the period in both relative and absolute terms.

Mortality due to diabetes declined in Brazil from 1996 to 2011, minimally in men and considerably in women. The lesser declines in recent years may reflect the increasing prevalence of diabetes, and suggest that current efforts to prevent diabetes and minimize the impact of its complications need to be reinforced to ensure that declines will continue.