Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study.
OBJECTIVE
To establish the age and sex specific mortality for people with diabetes in comparison with local and national background populations; to investigate the relationship between mortality and material deprivation in an unselected population with diabetes.


METHODS
Longitudinal study, using a population based district diabetes register.


METHODS
South Tees, United Kingdom.


METHODS
All people known to have diabetes living in Middlesbrough and Redcar and Cleveland local authorities on 1 January 1994.


METHODS
Death, from any cause, between 1 January 1994 and 31 December 1999.


RESULTS
Over the six years of the study 1205 (24.9%) of 4842 participants died. All cause standardised mortality ratios for type 1 diabetes were 641 (95% confidence interval 406 to 962) in women and 294 (200 to 418) in men, and those for type 2 diabetes were 160 (147 to 174) in women and 141 (130 to 152) in men. Cause specific standardised mortality ratios were increased for ischaemic heart disease, cerebrovascular disease, and renal disease; no reductions in mortality from other causes were seen. The risk of premature death increased significantly with increasing material deprivation (P<0.001).


CONCLUSIONS
Diabetes is associated with excess mortality, even in an area with high background death rates from cardiovascular disease. This excess mortality is evident in all age groups, most pronounced in young people with type 1 diabetes, and exacerbated by material deprivation. Aggressive approaches to the management of cardiovascular risk factors could reduce the excess mortality in people with diabetes.
Roper
N A
NA
Diabetes Care Centre, Middlesbrough General Hospital, Middlesbrough TS5 5AZ. n.a.roper@ncl.ac.uk
Bilous
R W
RW
Kelly
W F
WF
Unwin
N C
NC
Connolly
V M
VM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality; D011610:Psychosocial Deprivation; D012737:Sex Factors