title: Improving the comparability of diabetes mortality statistics in the U.S. and Mexico.
abstract: OBJECTIVE
  The aim of this study was to increase the cross-state comparability of diabetes mortality statistics related in the U.S. and Mexico.
  
  
  METHODS
  We used multinomial logistic regression to estimate the effects of individual and community factors on a death for which diabetes was recorded as one of the multiple contributing causes of death (MCD) being assigned to diabetes as the underlying cause of death (UCD) versus assignment to cardiovascular, other noncommunicable, or communicable diseases. We used the model to estimate state-level diabetes death rates that are standardized in the individual and community factors.
  
  
  RESULTS
  Deaths with diabetes as one of the MCD were more likely to be assigned to cardiovascular causes as the UCD if they occurred in hospitals or if an autopsy was performed and if the decedents were from states with higher BMI and systolic blood pressure, were more educated, or had insurance. Adjusting for individual- and community-level factors substantially increased the cross-state correlation of diabetes as the UCD and diabetes as one of the MCD mortality rates. The adjustment also reduced the number of direct diabetes deaths by 10% in the U.S. and by 24% in Mexico. In the U.S., deaths with diabetes as the UCD declined most in Utah, New Mexico, New Jersey, and Louisiana and increased in California and Hawaii. In Mexico, the numbers of adjusted diabetes deaths were smaller than those observed in all states by 3-34%. An additional 126,300 deaths due to ischemic heart disease and stroke in the U.S. and 19,497 in Mexico were attributable to high blood glucose.
  
  
  CONCLUSIONS
  There is a need to improve the comparability of diabetes cause-of-death assignment, especially in relation to cardiovascular diseases.
authors.affiliation: Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
authors.forename: Rodrigo H
authors.initials: RH
authors.lastname: Dias
authors.forename: Sandeep C
authors.initials: SC
authors.lastname: Kulkarni
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008800:Mexico / Q000453:epidemiology; D009026:Mortality / Q000639:trends*; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology