Mortality of Mexican Americans with NIDDM. Retinopathy and other predictors in Starr County, Texas.
OBJECTIVE
To determine the rate and risk factors of mortality in a cohort of Mexican Americans with NIDDM.


METHODS
A cohort of 353 Mexican Americans with NIDDM were identified between 1981 and 1986. All individuals underwent extensive evaluations that included physical, historical, ophthalmological, and laboratory assessments. This cohort was followed prospectively for a mean of 8 yr. Follow-up included mortality surveillance, death certificate extraction, and a combination of annual and intermediate examinations.


RESULTS
The cohort experienced 67 mortality events. One-third of all deaths were premature < 65 yr of age) and most often were attributed to diseases of the heart (60.0%). In no case was diabetes listed as the cause of death, although it was listed as a contributing cause in 25.5% of cases. Men had a higher mortality rate than women. In both sexes, baseline retinopathy was identified as an important predictor of subsequent mortality. Mortality was significantly elevated in those with nonproliferative retinopathy and even further elevated in those with proliferative disease (relative risks of > or = 4 for proliferative disease).


CONCLUSIONS
Mexican Americans with NIDDM are experiencing premature and excessive mortality compared with the general population. The results clearly link microvascular complications with macrovascular disease, but this link is not explained by a more untoward profile of traditional cardiovascular risk factors. Retinopathy appears to serve as an important monitor of the progression of diabetes and when identified would warrant aggressive action to inhibit or slow the processes leading to subsequent mortality.
Hanis
C L
CL
Center for Demographic and Population Genetics, Graduate School of Biomedical Sciences, University of Texas Health Science Center, Houston 77225.
Chu
H H
HH
Lawson
K
K
Hewett-Emmett
D
D
Barton
S A
SA
Schull
W J
WJ
Garcia
C A
CA
D000367:Age Factors; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003930:Diabetic Retinopathy / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012727:Sex Characteristics; D013781:Texas; D013997:Time Factors; D014481:United States