Changes in diabetes mortality rate in Costa Rica 2007-2017

Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is increasing and represents a significant burden.

To determine specific diabetes mortality rates (SDMR) in Costa Rica from 2007 to 2017 and explore it's potential causes.

Death certificates (classification CIE-10) were obtained from the Instituto Nacional de Estadística y Censos. All-cause mortality, SDMR, ischemic heart disease (IHD), cerebrovascular disease (CVD), and peripheral vascular disease mortality were assessed per year, sex, age and province. We evaluated relationships between SDMR and Index of Human Development (IHUD), performed a multivariate regression negative binomial model analysis and compared SDMR with goals of metabolic control in the primary care setting.

All-cause mortality and SDMR increased while IHD and CVD mortality rates remained invariable. SDMR was higher in females and in provinces with predominant rural areas. The years of observation, sex, age and province were significant predictors of death at a 5% level in people with diabetes. Reports from primary care setting showed inadequeate public health care coverage and insuficient metabolic control.

SDMR increased in elderly patients with specific complications. Age, place of residence and sex predicted SDMR. Unsatisfactory diabetes medical coverage and poorly diabetes management likely explain our findings.