Diabetes and Cause-Specific Mortality in Mexico City

Area of Science:

• Epidemiology
• Public Health
• Endocrinology

Background:

• Most diabetes mortality studies focus on high-income countries.
• Middle-income countries face rising obesity and diabetes rates with potentially poor glycemic control.
• Limited large-scale prospective data exists for diabetes impact in these settings.

Purpose of the Study:

• To investigate the association between diabetes and mortality in a middle-income country.
• To assess diabetes prognosis in a population with high obesity and potentially poor glycemic control.
• To compare diabetes mortality risks in Mexico to those reported in high-income countries.

Main Methods:

• Prospective cohort study in Mexico City (1998-2014) with ~150,000 participants (≥35 years).
• Recorded diabetes status, stored blood samples, and tracked 12-year mortality.
• Analyzed mortality rate ratios for participants with and without diabetes, excluding other chronic diseases.

Main Results:

• Diabetes prevalence increased with age, exceeding 20% by age 60.
• Participants with diabetes had poor glycemic control (HbA1c 9.0±2.4%) and low use of vasoprotective medications.
• Diabetes was associated with significantly higher mortality rates: RR 5.4 (35-59 yrs), 3.1 (60-74 yrs), 1.9 (75-84 yrs).
• Excess mortality from renal disease (RR 20.1), infection (RR 4.7), cardiac disease (RR 3.7), and diabetic crises was substantial.
• Diabetes accounted for one-third of all deaths between ages 35-74.

Conclusions:

• In middle-income Mexico, diabetes is common, poorly controlled, and associated with a substantially worse mortality prognosis than in high-income countries.
• Diabetes is a leading cause of death, responsible for at least one-third of all deaths in adults aged 35-74.
• Findings underscore the urgent need for improved diabetes management strategies in middle-income countries.