More death certificates cite diabetes as underlying cause of death

McEwen LN. Diabetes Care. 2011;34:1529-1533.

Death certificates now list diabetes as the underlying cause of death more often than in previous years, data from the Translating Research into Action for Diabetes trial suggest.

Of 2,261 participants enrolled in the study who died from 2000 to 2007, 41% had diabetes listed on their death certificates and 13% cited the disease as the underlying cause of death. These findings indicated increased reporting of diabetes as the underlying cause of death over time, the researchers said, although the frequency of the disease’s appearance on death certificates in general remained unchanged.

In contrast, the listing of cardiovascular disease as an underlying cause of death declined significantly throughout the study period, a factor that may have played a role in the increased reporting of diabetes as an underlying cause of death, the researchers said. They attributed this trend to a decrease in the reporting of cardiac causes of death for men and cerebrovascular causes of death for women. Diabetes was more likely to be recorded anywhere on the death certificate in decedents with CVD cited as the underlying cause of death.

“Although diabetes listed as any cause of death was stable over time, we have observed a statistically significant increase in reporting of diabetes as the underlying cause of death on death certificates between 2001 and 2008 independent of age at death and duration of diabetes at death,” the researchers wrote. “If this trend is indeed occurring on a national level, it may complicate the interpretation of mortality rates ascertained from death certificates.”

Disclosure: The researchers report no relevant financial disclosures.

Alan J. Garber

We know from independent sources that the incidence and prevalence of diabetes among the adult population of the US has increased by roughly 1 million individuals per year during the time period of this study. One would therefore expect a net increase in deaths from diabetes (defined as any entry in the death certificate). That such did not occur raises questions regarding the methodology of the study or the population surveyed, or both. Of course, CV death rates for both genders continue to decline whether diabetic or not during this same period of study. Thus, it may be that one effect cancels the other.

This study attributing underlying causes of death to diabetes is of importance for research funding since mortality impact is frequently used to asses the need for more disease-focused medical research. Therefore, research funding depends upon impact assessments such as this.

Alan J. Garber, MD
Cardiology Today Editorial Board

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