Mortality trends in men and women with diabetes, 1971 to 2000

Background: Whether mortality rates among diabetic adults or excess mortality associated with diabetes in the United States has declined in recent decades is not known. Objective: To examine whether all-cause and cardiovascular disease mortality rates have declined among the U.S. population with and without self-reported diabetes. Design: Comparison of 3 consecutive, nationally representative cohorts. Setting: Population-based health surveys (National Health and Nutrition Examination Surveys I, II, and III) with mortality follow-up assessment. Patients: Survey participants age 35 to 74 years with and without diabetes. Measurements: Diabetes was determined by self-report for each survey (1971-1975, 1976-1980, and 1988-1994), and mortality rates were determined through 1986, 1992, and 2000 for the 3 surveys, respectively. Results: Among diabetic men, the all-cause mortality rate decreased by 18.2 annual deaths per 1000 persons (from 42.6 to 24.4 annual deaths per 1000 persons; P = 0.03) between 1971 to 1986 and 1988 to 2000, accompanying decreases in the nondiabetic population. Trends for cardiovascular disease mortality paralleled those of all-cause mortality, with 26.4 annual deaths per 1000 persons in 1971 to 1986 and 12.8 annual deaths per 1000 persons in 1988 to 2000 (P = 0.06). Among women with diabetes, however, neither all-cause nor cardiovascular disease mortality declined between 1971 to 1986 and 1988 to 2000, and the all-cause mortality rate difference between diabetic and nondiabetic women more than doubled (from a difference of 8.3 to 18.2 annual deaths per 1000 persons). The difference in all-cause mortality rates by sex among people with diabetes in 1971 to 1986 were essentially eliminated in 1988 to 2000. Limitations: Diabetes was assessed by self-report, and statistical power to examine the factors explaining mortality trends was limited. Conclusions: Progress in reducing mortality rates among persons with diabetes has been limited to men. Diabetes continues to greatly increase the risk for death, particularly among women.