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17-01-2011 | Diabetes | Article

Mortality from diabetic kidney disease ‘grossly underestimated’


Free abstract

MedWire News: Routine underlying cause-of-death statistics for Australia and the USA "grossly underestimate" mortality from diabetic renal disease, say researchers.

"Clear guidelines on the certification, coding and statistical presentation of diabetes mortality are needed for epidemiology and health policy," say Suhail Doi (University of Queensland, Herston, Australia) and colleagues.

The researchers report results from an analysis of multiple causes of death from Australian and US death registration data. They contrasted deaths listed as having "diabetes" as an underlying cause and renal failure as a consequence with those listed as having "diabetes with renal complications" as an underlying cause of death.

Doi and team found that 75% of all diabetes deaths in these two countries are automatically coded as being from "diabetes without complications," despite additional comorbidities or complications being listed.

They estimate that multiple-cause deaths from diabetic renal disease are between four and nine times higher than underlying cause death rates for "diabetes with renal complications."

In other words, the current automated systems in these countries "do not include deaths for which renal failure is listed as a consequence of diabetes within the coding rubric 'diabetes with renal complications,'" the team explains, leading to gross underestimation of deaths from diabetic renal disease.

The researchers say: "Multiple cause of death analysis is essential to capture mortality from diabetic renal disease to prevent spurious interpretations based on underlying cause statistics."

They conclude that "the observed marginal decline in the underlying cause rate for 'diabetes with renal complications' in both countries is likely to be spurious, and both these important findings warrant immediate attention."

The results of this study are published in the European Journal of Public Health.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Helen Albert