Diabetes Contribution to Deaths Underestimated; Third Leading Cause

Marlene Busko

January 31, 2017

A new study based on recent national surveys estimates that diabetes accounts for many more deaths in the United States than are being reported on death certificates — and that diabetes is actually the third leading cause of death.

Specifically, about 12% of deaths in 30- to 84-year-olds from 1997 to 2011 could be attributed to diabetes, the latest data from the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES) indicate.

But during that time, only 3.3% of death certificates listed diabetes as the underlying cause of death.

The findings, by Andrew Stokes, PhD, a demographer at the Center for Global Health and Development, Boston University School of Public Health, in Massachusetts, and Samuel H Preston, PhD, of the department of sociology and Population Studies Center, University of Pennsylvania, in Philadelphia, were published online January 25 in PLOS ONE.

"Responsibility for approximately 12% of deaths would make diabetes the third leading cause of death in the United States in 2010, after diseases of the heart and malignant neoplasms and ahead of chronic lower respiratory diseases and cerebrovascular diseases," Drs Stokes and Preston write.

"When we monitor trends in the health of populations and we look at the mortality statistics," Dr Stokes noted in a statement, "some major threats to US mortality and life expectancy stand out, like drug and alcohol poisonings and suicide. Diabetes didn't."

However, these findings show that diabetes is a major contributor to a shorter lifespan and "reinforce the need for robust population-level interventions aimed at diabetes prevention and care," the researchers conclude.

Obesity and Diabetes Slow Down Increases in Life Expectancy

According to previous reports, in 2010, diabetes was the seventh leading cause of death in the United States, and it was listed as the cause of death on 69,000 death certificates (2.8% of total deaths), Drs Stokes and Preston note.

However, death certificates list only one underlying cause of death and tend to underestimate diabetes as the cause, especially if the deceased person had both diabetes and cardiovascular disease, they say.

Instead of looking at death certificates, nationally representative surveys may provide a better estimate of the fraction of deaths attributable to diabetes.

Using this approach, other researchers have reported that, based on NHANES data from 1976 to 1980, diabetes was responsible for 3.6% of deaths in the United States, or 5.1% of deaths if undiagnosed diabetes was included (Am J Epidemiol. 2002;156:714-719).

Drs Stokes and Preston aimed to determine the fraction of deaths attributable to diabetes in more recent cohorts.

They analyzed data from 282,322 individuals who took part in NHIS surveys between 1997 and 2009 and 21,824 individuals who participated in NHANES between 1999 and 2010.

They also looked at mortality in the 5 years following the surveys.

The number of deaths that could be attributed to diabetes was 11.5% based on self-reported diabetes in NHIS, 11.7% based on self-reported diabetes in NHANES, and 11.8% based on HbA1c levels (>6.5%) in NHANES.

The proportion of deaths that could be attributed to diabetes was highest among obese people: 19.4%.

The prevalence of diabetes has tripled from 1976–1980 until now, Drs Stoke and Preston point out.

According to the Centers for Disease Control and Prevention, in 1980, 5.53 million people in the United States had diabetes, but by 2014 — the most recent year for which statistics are available — the prevalence had soared to 21.95 million people.

At the same time, "American life expectancy has been growing at a very slow rate for the past decade or so, even decreasing slightly in 2015," Dr Preston noted, adding that "it's fairly likely that obesity and diabetes together are an important factor in this slowdown."

This research highlights that "strategies at the population level to combat the epidemics of obesity and diabetes" are needed, he concluded.

The study was funded by the National Institute on Aging and the National Center for Health Statistics. The authors report no relevant financial relationships.

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PLoS ONE. Published online January 25, 2017. Article

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