title: Diabetes as a tracer condition in international benchmarking of health systems.
abstract: OBJECTIVE
  To assess the performance of health systems using diabetes as a tracer condition.
  
  
  METHODS
  We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population.
  
  
  RESULTS
  The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada.
  
  
  CONCLUSIONS
  The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them.
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, UK. ellen.nolte@lshtm.ac.uk
authors.forename: Ellen
authors.initials: E
authors.lastname: Nolte
authors.forename: Chris
authors.initials: C
authors.lastname: Bain
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D019985:Benchmarking; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D005060:Europe; D006308:Health Systems Plans; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008017:Life Expectancy; D009026:Mortality; D006113:United Kingdom; D014481:United States / Q000453:epidemiology