Some 3.8 million men and women worldwide were estimated to have died from diabetes-related causes in the year 2007. This is more than 6% of total world mortality. Over two-thirds of deaths attributable to diabetes occur in developing countries.
Routine health statistics based upon death certification seriously underestimate mortality from diabetes 1 . This is because only a minority of persons with diabetes die from a cause uniquely related to the condition, such as diabetic ketoacidosis or hypoglycaemia. About 50% of persons with diabetes die of cardiovascular disease, and 10-20% die of renal failure 2 .
A study of death certificate coding practices in nine European countries demonstrated that much of the reported variation in diabetes mortality was due to variations in certification practices and in the national coding procedures for assigning the ‘underlying cause of death’ 3 . Most of the variations concerned the coding of co-morbidity involving diabetes and ischaemic heart disease or stroke. Analysing all the conditions mentioned on the certificate was shown to overcome some of these problems 4 . However, multiple-cause encoding is not likely to become generally available, even in industrialized countries, because of the cost involved. Another problem is that only some 30% of deaths worldwide are medically certified, and alternative sources of information have to be identified to obtain information on causation.
This section estimates the number of deaths attributable to diabetes in the year 2007 in persons 20-79 years old using DisMod II, a software programme.
1.Fuller,J.H. Elford,J. Goldblatt,P. Adelstein,A.M. Diabetes mortality: new light on an underestimated public health problem. Diabetologia.1983; 24: 336-341
2.Morrish,N.J. Wang,S.L. Stevens,L.K. Fuller,J.H. Keen,H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia.2001; 44 Suppl 2: S14-S21
3.Jougla,E. Papoz,L. Balkau,B. Maguin,P. Hatton,F. Death certificate coding practices related to diabetes in European countries. Int J Epidemiol.1992; 21(2): 343-351
4.Fuller,J.H. Mortality trends and causes of death in diabetic patients. Diabet Metab.1993; 19(1 Pt 2): 96-99