title: Diabetes reporting as a cause of death: results from the Translating Research Into Action for Diabetes (TRIAD) study.
abstract: OBJECTIVE
  To determine the frequency of reporting of diabetes on death certificates of decedents with known diabetes, define factors associated with reporting of diabetes, and describe trends in reporting over time.
  
  
  METHODS
  Data were obtained from 11,927 participants with diabetes who were enrolled in the Translating Research Into Action for Diabetes study, a multicenter prospective observational study of diabetes care in managed care. Data on decedents (n = 540) were obtained from the National Death Index. The primary dependent variable was the presence of ICD-10 codes for diabetes on the death certificate. Covariates included age at death, sex, race/ethnicity, education, income, duration of diabetes, type of diabetes, diabetes treatment, smoking status, and number of comorbidities.
  
  
  RESULTS
  Diabetes was recorded on 39% of death certificates and as the underlying cause of death for 10% of decedents with diabetes. Diabetes was significantly less likely to be reported on the death certificates of decedents with diabetes dying of cancer. Predictors of recording diabetes anywhere on the death certificate included longer duration of diabetes and insulin treatment. Longer duration of diabetes, insulin treatment, and fewer comorbidities were associated with recording of diabetes as the underlying cause of death.
  
  
  CONCLUSIONS
  Diabetes is much more likely to be reported on the death certificates of diabetic individuals who die of cardiovascular causes. Reporting of diabetes on death certificates has been stable over time. Death certificates underestimate the prevalence of diabetes among decedents and present a biased picture of the causes of death among people with diabetes.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Laura N
authors.initials: LN
authors.lastname: McEwen
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
authors.forename: Mary
authors.initials: M
authors.lastname: Haan
authors.forename: Debashis
authors.initials: D
authors.lastname: Ghosh
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: David
authors.initials: D
authors.lastname: Marrero
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Thompson
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
mesh_terms: D002423:Cause of Death; D015897:Comorbidity; D003644:Death Certificates; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology