All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992-1999.
OBJECTIVE
We compiled up to date estimates of the absolute and relative risk of all-cause mortality in patients with type 1 diabetes in the UK.


METHODS
We selected patients with type 1 diabetes (n=7,713), and for each of these diabetic subjects five age- and sex-matched control subjects without diabetes (n=38,518) from the General Practice Research Database (GPRD). Baseline was 1 January 1992; subjects were followed until 1999. The GPRD is a large primary-care database containing morbidity and mortality data of a large sample representative of the UK population. Deaths occurring in the follow-up period were identified.


RESULTS
The study comprised 208,178 person-years of follow-up. The prevalence of type 1 diabetes was 2.15/1,000 subjects in 1992 (mean age 33 years, SD 15). Annual mortality rates were 8.0 per 1,000 person-years (95% CI 7.2-8.9) in type 1 diabetic subjects compared with 2.4 per 1,000 person-years (95% CI 2.2-2.6) in those without diabetes (hazard ratio [HR]=3.7, 95% CI 3.2-4.3). The increased mortality rates in patients with type 1 diabetes were apparent across all age-bands. The HR was higher in women (HR=4.5, 95% CI 3.5-5.6 compared with non-diabetic women) than men (HR=3.3, 95% CI 2.7-4.0), such that the sex difference (p<0.0001) in mortality in the non-diabetic population was abolished (p=0.3) in the type 1 diabetic patients. The predominant cause of death in patients with type 1 diabetes was cardiovascular disease.


CONCLUSIONS
Despite advances in care, UK mortality rates in the past decade continue to be much greater in patients with type 1 diabetes than in those without diabetes.
Soedamah-Muthu
S S
SS
Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, UK. s.s.soedamah-muthu@umcutrecht.nl
Fuller
J H
JH
Mulnier
H E
HE
Raleigh
V S
VS
Lawrenson
R A
RA
Colhoun
H M
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D016208:Databases, Factual; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D006113:United Kingdom / Q000453:epidemiology