title: Excess mortality in Black compared with White patients with Type 1 diabetes: an examination of underlying causes.
abstract: OBJECTIVE
  Excess mortality in Type 1 diabetes has previously been found among Black individuals. The aim of the present study was therefore to determine underlying causes.
  
  
  METHODS
  A longitudinal study of 1261 [1184 White (93.9%) and 76 Black (6.0%)] individuals diagnosed with Type 1 diabetes between 1965 and 1979, at age<17 years from the Allegheny County, Pennsylvania and Children's Hospital of Pittsburgh registries. Subjects were contacted in 1999 to determine living status and, where appropriate, cause of death. Living status was determined in 1183 participants (93.8%).
  
  
  RESULTS
  Of the 200 deaths overall, cause of death was determined in 157 subjects (79%); 31 dying from acute and 101 from chronic complications, and 25 from non-diabetes related causes. Seven deaths were investigated but no cause determined. Black participants had a significantly higher mortality rate compared with White participants for acute complications (hazard ratio=4.9, 95% confidence interval: 2.0, 11.6), but not for any other cause. There was a temporal decline in the 20-year mortality rates in both racial groups across the three cohorts diagnosed in 1965-69, 1970-74 and 1975-79.
  
  
  CONCLUSIONS
  These results show that the excess mortality in Black people was attributed to acute complications which therefore should be a focus for prevention.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, and Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Bosnyak
authors.forename: R
authors.initials: R
authors.lastname: Nishimura
authors.forename: M
authors.initials: M
authors.lastname: Hagan Hughes
authors.forename: N
authors.initials: N
authors.lastname: Tajima
authors.forename: D
authors.initials: D
authors.lastname: Becker
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000208:ethnology*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D044465:White People / Q000208:ethnology*