Excess mortality in incident cases of diabetes mellitus aged 15 to 34 years at diagnosis: a population-based study (DISS) in Sweden.
OBJECTIVE
The objective of the study was to analyse the mortality, survival and cause of death patterns in incident cases of diabetes in the 15-34-year age group that were reported to the nationwide prospective Diabetes Incidence Study in Sweden (DISS).


METHODS
During the study period 1983-1999, 6,771 incident cases were reported. Identification of deaths was made by linking the records to the nationwide Cause of Death Register.


RESULTS
With an average follow-up of 8.5 years, resulting in 59,231 person-years, 159 deaths were identified. Diabetes was reported as the underlying cause of death in 51 patients (32%), and as a contributing cause of death in another 42 patients (26%). The standardised mortality ratio (SMR) was significantly elevated (RR=2.4; 95% CI: 2.0-2.8). The SMR was higher for patients classified by the reporting physician as having type 2 diabetes at diagnosis than for those classified as type 1 diabetic (2.9 and 1.8, respectively). Survival analysis showed significant differences in survival curves between males and females (p=0.0003) as well as between cases with different types of diabetes (p=0.005). This pattern was also reflected in the Cox regression model showing significantly increased hazard for males vs females (p=0.0002), and for type 2 vs type 1 (p=0.015) when controlling for age.


CONCLUSIONS
This study shows a two-fold excess mortality in patients with type 1 diabetes and a three-fold excess mortality in patients with type 2 diabetes. Thus, despite advances in treatment, diabetes still carries an increased mortality in young adults, even in a country with a good economic and educational patient status and easy access to health care.
Waernbaum
I
I
Department of Public Health and Clinical Medicine, Division of Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden. Ingeborg.Waernbaum@stat.umu.se
Blohmé
G
G
Ostman
J
J
Sundkvist
G
G
Eriksson
J W
JW
Arnqvist
H J
HJ
Bolinder
J
J
Nyström
L
L
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D003644:Death Certificates; D003710:Demography; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors