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14-05-2019 | Diabetes | News | Article

Diabetes-related mortality rates are no longer declining

medwireNews: Rates of age-standardized all-cause mortality due to diabetes as the underlying or contributing cause of death have plateaued in recent years following earlier declines, shows an analysis of data from the US Census and national mortality database.

Cardiovascular and cancer-related mortality rates have shown a similar pattern among people with diabetes, with the exception of deaths due to hypertensive heart disease or heart failure, which have both increased in recent years, Aijaz Ahmed and colleagues from Stanford University School of Medicine in Palo Alto, California, USA, report in Diabetologia.

Between 2007 and 2017, there were 27,903,198 deaths among US adults aged 20 years and older, including 2,686,590 (9.6%) where diabetes was recorded as an underlying or contributing cause (all-cause mortality).

Of these, cardiovascular disease (CVD) was the underlying cause of death in 33% of cases, diabetes in 31%, and cancer in 11%.

Overall, the age-standardized all-cause diabetes mortality rate was 105.1 per 100,000 individuals during the study period, with rates of 32.2 and 75.7 per 100,000 individuals for diabetes as an underlying and contributing cause of death, respectively.

Ahmed et al point out that current estimates of diabetes-related mortality generally only include cases where diabetes was an underlying cause of death. These data show however, that this approach “may fail to capture diabetes-related mortality attributed to CVD, cancer and other causes of death.”

In 2017, the age-standardized mortality rate due to diabetes as an underlying or contributing cause of death was 112.2 per 100,000 individuals, a significant 0.7% annual decline from the rate of 104.3 per 100,000 individuals in 2007.

However, the researchers note that “the most pronounced decline” occurred between 2007 and 2014, at a rate of 1.4% per year, and was then followed by a stabilization from 2014 to 2017, during which time the mortality rate increased by a nonsignificant 1.1% per year.

In terms of cause-specific mortality, rates of age-standardized diabetes-related deaths in this cohort declined by a significant 4.5% per year from 2007 to 2009, and then stabilized, with an annual percent change of 0.1% thereafter.

Cancer-related death rates declined by an average of 1.4% per year during the study, with no biphasic pattern seen, while cardiovascular mortality rates fell by 1.2% per year on average, with a marked decline of 2.3% per year observed between 2007 and 2014.

But Ahmed and co-authors point out that cardiovascular mortality rates differed among the different categories of disease. Specifically, age-standardized mortality rates for both ischemic heart disease and cerebrovascular disease declined significantly between 2007 and 2014 and then stabilized from 2014 to 2017, whereas the rate for heart failure declined from 2007 to 2011 but then subsequently increased for the remainder of the study.

Finally, mortality rates for hypertensive heart disease increased by 2.3% per year from 2007 to 2014 and then by a steeper 7.3% from 2014 to 2017.

The investigators describe this finding as “surprising” and say that it suggests “that other processes, perhaps less well-treated, which increase the risk of hypertensive heart disease and heart failure are not as affected by current clinical care best practices.”

And they conclude: “Our results suggest that greater efforts are needed to prevent mortality from CVD and complications associated with diabetes in the future.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetologia 2019; doi:10.1007/s00125-019-4870-9