A cohort analysis of type 1 diabetes mortality in Havana and Allegheny County, Pittsburgh, PA.
OBJECTIVE
To examine the mortality of type 1 diabetes (T1D) in two countries with very different health care systems using two population-based registries of childhood-onset T1D one in Havana (HA), Cuba, and the other in Allegheny County (AC), USA.


METHODS
Cases diagnosed with T1D between 1965 and 1980 in HA and between 1965 and 1979 in AC were included. Follow-up started with diagnosis in each individual and ended as of 1 January 1991, or with death. Life-table analyses were used to examine the mortality rates in both populations by duration of diabetes.


RESULTS
Cumulative mortality by January 1991 in HA (14% in males and females, respectively) was higher than in AC (7% in males and 9% in females) for both genders (males, p=0.0005; females, p=0.0491). Mortality rates were considerably higher in HA for both men and women than in AC however, among females confidence intervals overlapped. Overall mortality rate for Caucasians (AC) was significantly lower than that for African-Americans (AC) or Hispanics (HR). An analysis of causes of death showed a greater proportion of deaths attributed to nephropathy (48.6%) in HA while acute complications (36%) and infections (27%) were more frequent in AC.


CONCLUSIONS
This study shows a two-fold greater mortality among people with childhood-onset T1D in Havana, Cuba, than in Allegheny, USA. Different strategies may be needed to increase survival among those with type 1 diabetes in the USA and Cuba.
Barceló
A
A
Non-Communicable Diseases, Disease Prevention & Control, Pan American Health Organization, Regional Office of the World Health Organization, 525 23rd Street, N.W., Washington, DC 20037, USA. barceloa@paho.org
Bosnyak
Z
Z
Orchard
T
T
D017668:Age of Onset; D015331:Cohort Studies; D003462:Cuba / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries