title: Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes.
abstract: OBJECTIVE
  We aimed to examine the mortality rates, excess mortality and causes of death in diabetic patients from ten centres throughout the world.
  
  
  METHODS
  A mortality follow-up of 4713 WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) participants from ten centres was carried out, causes of death were ascertained and age-adjusted mortality rates were calculated by centre, sex and type of diabetes. Excess mortality, compared with the background population, was assessed in terms of standardised mortality ratios (SMRs) for each of the 10 cohorts.
  
  
  RESULTS
  Cardiovascular disease was the most common underlying cause of death, accounting for 44 % of deaths in Type I (insulin-dependent) diabetes mellitus and 52 % of deaths in Type II (non-insulin-dependent) diabetes mellitus. Renal disease accounted for 21% of deaths in Type I diabetes and 11% in Type II diabetes. For Type I diabetes, all-cause mortality rates were highest in Berlin men and Warsaw women, and lowest in London men and Zagreb women. For Type II diabetes, rates were highest in Warsaw men and Oklahoma women and lowest in Tokyo men and women. Age adjusted mortality rates and SMRs were generally higher in patients with Type I diabetes compared with those with Type II diabetes. Men and women in the Tokyo cohort had a very low excess mortality when compared with the background population.
  
  
  CONCLUSIONS
  This study confirms the importance of cardiovascular disease as the major cause of death in people with both types of diabetes. The low excess mortality in the Japanese cohort could have implications for the possible reduction of the burden of mortality associated with diabetes in other parts of the world.
authors.affiliation: North Bedfordshire Diabetes Centre, Bedford Hospital, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Morrish
authors.forename: S L
authors.initials: SL
authors.lastname: Wang
authors.forename: L K
authors.initials: LK
authors.lastname: Stevens
authors.forename: J H
authors.initials: JH
authors.lastname: Fuller
authors.forename: H
authors.initials: H
authors.lastname: Keen
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D014944:World Health Organization