Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes.
OBJECTIVE
Little is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population.


METHODS
The Allegheny County (Pennsylvania) childhood-onset (age < 18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965 to 1979 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least three physician epidemiologists, based on the death certificate and additional records surrounding the death.


RESULTS
Vital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years' duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (P < 0.05) and African Americans (P < 0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. Standardized mortality ratios (SMRs) for non-diabetes-related causes do not significantly differ from the general population (violent deaths: SMR 1.2, 95% CI 0.6-1.8; cancer: SMR 1.2, 0.5-2.0).


CONCLUSIONS
The excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities but varies by duration of diabetes and particularly affects women and African Americans.
Secrest
Aaron M
AM
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Becker
Dorothy J
DJ
Kelsey
Sheryl F
SF
Laporte
Ronald E
RE
Orchard
Trevor J
TJ
D000293:Adolescent; D017668:Age of Onset; D044383:Black People / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality; D005260:Female; D006801:Humans; D007239:Infections / Q000401:mortality; D008297:Male; D009369:Neoplasms / Q000401:mortality; D010414:Pennsylvania / Q000453:epidemiology; D044469:Racial Groups; D012042:Registries; D012727:Sex Characteristics; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American