PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Epidemiol Community Health. 1995 December; 49(6): 570–574.
PMCID: PMC1060170

Insulin treated diabetes mellitus: causes of death determined from record linkage of population based registers in Leicestershire, UK.

Abstract

STUDY OBJECTIVE--Analyses of causes of mortality in people with diabetes using data form death certificates mentioning diabetes provide unreliable estimates of mortality. Under-recording of diabetes as a cause on death certificates has been widely reported, ranging from 15-60%. Using a population based register on people with diabetes and linking data from another source is a viable alternative. Data from the Office of Population Censuses and Surveys (OPCS) are the most acceptable mortality data available for such an exercise, as direct comparison with other published mortality rates is then possible. DESIGN--A locally maintained population-based mortality register and all insulin-treated diabetes mellitus cases notified to the Leicestershire diabetes register (n = 4680) were linked using record linkage software developed in-house (Lynx). This software has been extensively used in a maintenance and update cycle designed to maximise accuracy and minimise duplication and false registration on the diabetes register. Deaths identified were initially coded locally to the International Classification of Diseases, 9th revision (ICD9), and later a linkage was performed to use official OPCS coding. Mortality data identified by the linkage was indirectly standardised using population data for Leicestershire for 1991. Standardised mortality ratios (SMR) were estimated, with 95% confidence intervals. Insulin dependent diabetes (IDDM) was defined as diabetes diagnosed before age 30 years with insulin therapy begun within one year of diagnosis. All other types were considered non-insulin dependent diabetes (NIDDM). Analyses were performed for the whole sample and then for the NIDDM subgroup. Results from these analyses were similar and therefore only whole group analyses are presented. MAIN RESULTS--A total of 370 deaths were identified for the period of 1990-92 inclusive - 56% were in men and 44% in women, median age (range) 71 years (12-94). Approximately 90% of deaths were subjects with NIDDM. Diabetes was mentioned on 215 (58%) death certificates. The all causes SMRs were significantly raised for men and women for all ages less than 75 years. Ischaemic heart disease (ICD9) rubrics 410-414) accounted for 146 (40%) deaths - 41% of male and 38% of female deaths. Male and female SMRs were significantly raised for the age groups 45-64, 65-74, and 75-84 years. Cerebrovascular disease (ICD9 rubrics 430-438) accounted for 39 (10%) deaths and the SMR for women the external causes of death (ICD9 rubrics E800-E999) were also significantly raised overall and in age groups 15-44 and 45-64 years. This was not true for men, although numbers of deaths in this category were small for both men (4) and women (9). CONCLUSION--Record linkage has been used successfully to link two local, population based registers. This has enabled an analysis of mortality in people with diabetes to be performed which overcomes the problems associated with using as a sample, death certificates where diabetes is mentioned. The mortality rates and SMRs estimated should more accurately reflect the true rates than would be possible using other methods. The persisting excess mortality identified for people with diabetes is of a similar magnitude and attributable to similar causes as has been reported elsewhere in population based studies.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (880K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Green A, Hougaard P. Epidemiological studies of diabetes mellitus in Denmark: 5. Mortality and causes of death among insulin-treated diabetic patients. Diabetologia. 1984 Mar;26(3):190–194. [PubMed]
  • Whittall DE, Glatthaar C, Knuiman MW, Welborn TA. Deaths from diabetes are under-reported in national mortality statistics. Med J Aust. 1990 Jun 4;152(11):598–600. [PubMed]
  • Fuller JH, Elford J, Goldblatt P, Adelstein AM. Diabetes mortality: new light on an underestimated public health problem. Diabetologia. 1983 May;24(5):336–341. [PubMed]
  • Wong JS, Pearson DW, Murchison LE, Williams MJ, Narayan V. Mortality in diabetes mellitus: experience of a geographically defined population. Diabet Med. 1991 Feb-Mar;8(2):135–139. [PubMed]
  • Ochi JW, Melton LJ, 3rd, Palumbo PJ, Chu CP. A population-based study of diabetes mortality. Diabetes Care. 1985 May-Jun;8(3):224–229. [PubMed]
  • Moss SE, Klein R, Klein BE. Cause-specific mortality in a population-based study of diabetes. Am J Public Health. 1991 Sep;81(9):1158–1162. [PubMed]
  • McNally PG, Burden AC, Swift PG, Walls J, Hearnshaw JR. The prevalence and risk factors associated with the onset of diabetic nephropathy in juvenile-onset (insulin-dependent) diabetics diagnosed under the age of 17 years in Leicestershire 1930-1985. Q J Med. 1990 Aug;76(280):831–844. [PubMed]
  • Nyström L, Ostman J, Wall S, Wibell L. Mortality of all incident cases of diabetes mellitus in Sweden diagnosed 1983-1987 at age 15-34 years. Diabetes Incidence Study in Sweden (DISS) Group. Diabet Med. 1992 Jun;9(5):422–427. [PubMed]
  • Dorman JS, Laporte RE, Kuller LH, Cruickshanks KJ, Orchard TJ, Wagener DK, Becker DJ, Cavender DE, Drash AL. The Pittsburgh insulin-dependent diabetes mellitus (IDDM) morbidity and mortality study. Mortality results. Diabetes. 1984 Mar;33(3):271–276. [PubMed]
  • Kleinman JC, Donahue RP, Harris MI, Finucane FF, Madans JH, Brock DB. Mortality among diabetics in a national sample. Am J Epidemiol. 1988 Aug;128(2):389–401. [PubMed]
  • Sprafka JM, Pankow J, McGovern PG, French LR. Mortality among type 2 diabetic individuals and associated risk factors: the Three City Study. Diabet Med. 1993 Aug-Sep;10(7):627–632. [PubMed]
  • Langley JD, Botha JL. Use of record linkage techniques to maintain the Leicestershire Diabetes Register. Comput Methods Programs Biomed. 1994 Jan;41(3-4):287–295. [PubMed]
  • Sartor G, Nyström L, Dahlquist G. The Swedish Childhood Diabetes Study: a seven-fold decrease in short-term mortality? Diabet Med. 1991 Jan;8(1):18–21. [PubMed]
  • Borch-Johnsen K, Kreiner S, Deckert T. Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia. 1986 Nov;29(11):767–772. [PubMed]
  • Green A, Borch-Johnsen K, Andersen PK, Hougaard P, Keiding N, Kreiner S, Deckert T. Relative mortality of type 1 (insulin-dependent) diabetes in Denmark: 1933-1981. Diabetologia. 1985 Jun;28(6):339–342. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group