title: Changes in certification of diabetes with cardiovascular diseases increased reported diabetes mortality in Australia and the United States.
abstract: OBJECTIVE
  This paper seeks to better understand diabetes-related mortality in Australia and the United States through analysis of the impact of certification practices of diabetes as a multiple cause of death, specifically with cardiovascular diseases (CVDs).
  
  
  METHODS
  Vital registration multiple cause of death data in Australia and the United States since 1999 are used to examine trends in the ratio of diabetes reported in Part I (underlying cause) and Part II (associated cause) of the death certificate, when CVDs are also reported.
  
  
  RESULTS
  Underlying cause of death (UCOD) statistics mask the magnitude of diabetes-related mortality. In both countries, since 1999 there has been an increase in the ratio of diabetes deaths in Part I vs. Part II where CVD deaths, including ischemic heart disease and cerebrovascular diseases, are also reported. In Australia, diabetes reported as an UCOD would be 12% lower in 2006 if the ratio from 1999 was applied.
  
  
  CONCLUSIONS
  The increasing likelihood of physicians to report diabetes in Part I reflects the subjectivity of diabetes death certification. There is a need for specific guidelines on death certification of diabetes with cardiovascular conditions, relating to its reporting as an underlying or associated cause.
authors: School of Population Health, University of Queensland, Public Health Building, Herston Road, Herston, QLD 4006, Australia. t.adair@uq.edu.au
authors: Timothy
authors: T
authors: Adair
authors: Chalapati
authors: C
authors: Rao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000401:mortality; D003644:Death Certificates; D048909:Diabetes Complications / Q000401:mortality*; D006801:Humans; D017202:Myocardial Ischemia / Q000401:mortality; D014481:United States / Q000453:epidemiology