title: The burden of diabetes-related mortality in France in 2002: an analysis using both underlying and multiple causes of death.
abstract: OBJECTIVE
  To describe the burden of diabetes-related mortality in France.
  
  
  METHODS
  Underlying and multiple causes (all causes listed) of death were extracted from the 2002 French national mortality registry. Death rates were standardized on the age structure of the European population.
  
  
  RESULTS
  Diabetes was reported as the underlying cause of death in 11,177 certificates (2.1%), and as multiple causes in 29,357 certificates (5.3%), giving a ratio (multiple/underlying causes) of 2.6. When diabetes was a multiple cause, the mean age at death was 75 years in men, 81 years in women. The age-standardized mortality rates were 41.0/100,000 in men, 24.6/100,000 in women. The excess mortality observed in men (men/women ratio = 1.7) decreased with age. Geographic differences were observed: higher rates in the North-East, lower rates in the West of the country. In certificates mentioning diabetes, the most frequent cause of death was diseases of the circulatory system (76%). Coronary heart diseases, foot ulcers and renal diseases were more likely to be mentioned in certificates referring to diabetes than in those that did not.
  
  
  CONCLUSIONS
  The use of multiple rather than underlying causes of death more than doubled diabetes-related mortality rates. While probably still under-estimated, the burden of diabetes-related mortality corresponds to a high proportion of the total mortality, especially in men. Geographic differences partially reflect disparities in diabetes prevalence. Causes more frequently associated with diabetes include coronary heart disease and complications related to neuropathy and nephropathy.
authors.affiliation: French Institute for Public Health Surveillance, Institut de Veille Sanitaire (InVS), 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France. i.romon@invs.sante.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romon
authors.forename: Eric
authors.initials: E
authors.lastname: Jougla
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.forename: Anne
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003644:Death Certificates; D048909:Diabetes Complications / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012737:Sex Factors